Casari Maria E, Chartier Christian, Gfrerer Lisa, Austen William G
From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School.
Plast Reconstr Surg. 2023 May 1;151(5):1071-1077. doi: 10.1097/PRS.0000000000010044. Epub 2022 Dec 23.
Radiofrequency ablation (RFA) of the greater occipital nerve (GON) is a minimally invasive treatment option commonly used in patients with occipital neuralgia. Patients who undergo occipital surgery for headaches after failed RFA treatment present a unique opportunity to evaluate RFA-treated occipital nerves and determine the impact on headache surgery outcomes.
Of 115 patients who underwent headache surgery at the occipital site, 29 had a history of RFA treatment. Migraine Headache Index, Pain Self- Efficacy Questionnaire, and Pain Health Questionnaire-2 outcome scores were recorded preoperatively and at follow-up visits. Intraoperative macroscopic nerve damage and surgical outcomes were compared between RFA-treated and non-RFA-treated patients.
RFA-treated patients had a higher rate of macroscopic nerve damage (45%) than non-RFA-treated patients (24%) ( P = 0.03), and they were significantly more likely to require a second operation at the site of primary decompression (27.6% versus 5.8%; P = 0.001) and GON transection (13.8% versus 3.5%; P = 0.04). Outcome scores at the last follow-up visit showed no statistically significant difference between RFA-treated and non-RFA-treated patients ( P = 0.96).
RFA-treated patients can ultimately achieve outcomes that are not significantly different from non-RFA-treated patients in occipital headache surgery. However, a higher number of secondary operations at the site of primary decompression and nerve transection are required to treat refractory symptoms. RFA-treated patients should be counseled about an increased risk of same-site surgery and possible GON transection to achieve acceptable outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
枕大神经（GON）的射频消融术（RFA）是枕神经痛患者常用的一种微创治疗选择。经RFA治疗失败后接受枕部头痛手术的患者为评估经RFA治疗的枕神经以及确定其对头痛手术结果的影响提供了独特的机会。
在115例行枕部头痛手术的患者中，29例有RFA治疗史。术前及随访时记录偏头痛头痛指数、疼痛自我效能问卷和疼痛健康问卷-2的结果评分。比较RFA治疗组和非RFA治疗组患者术中肉眼可见的神经损伤情况及手术结果。
RFA治疗组患者肉眼可见神经损伤的发生率（45%）高于非RFA治疗组患者（24%）（P = 0.03），且RFA治疗组患者在初次减压部位（27.6% 对5.8%；P = 0.001）和GON横断术（13.8% 对3.5%；P = 0.04）时更有可能需要二次手术。最后一次随访时的结果评分显示，RFA治疗组和非RFA治疗组患者之间无统计学显著差异（P = 0.96）。
在枕部头痛手术中，RFA治疗组患者最终可获得与非RFA治疗组患者无显著差异的结果。然而，为治疗难治性症状，在初次减压部位和神经横断术时需要进行更多的二次手术。应告知接受RFA治疗的患者，同部位手术风险增加以及可能需要进行GON横断术以获得可接受的结果。
临床问题/证据级别：治疗性，III级
