小儿枕神经痛的外科治疗：一种罕见病症的单中心经验

Surgical management of pediatric occipital neuralgia: a single-center experience of an uncommon pathology.

作者信息

Villeneuve Lance M, Coulibaly Nangorgo J, Raza Syed M, Poinson Brittany, Chrusciel Deepti, Desai Virendra R

机构信息

1Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and.

2Department of Pediatric Neurology, Oklahoma Children's Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

出版信息

J Neurosurg Pediatr. 2023 Jul 28;32(4):514-521. doi: 10.3171/2023.5.PEDS22554. Print 2023 Oct 1.

DOI:10.3171/2023.5.PEDS22554

PMID:37548543

Abstract

OBJECTIVE

Occipital neuralgia (ON) is a rare headache disorder characterized by sharp pain in the distribution of the greater occipital nerve (GON), lesser occipital nerve, or third occipital nerve. ON is commonly associated with traumatic injury, and effective identification and diagnosis can be difficult given the infrequent presentation and similarities to other pediatric headache disorders. While GON decompression has been well described in adults for refractory pain, there is a paucity of data in the pediatric population, with no previously published series on ON. The primary aim of this study was to identify the characteristics of pediatric patients with ON prior to surgical intervention and to describe the natural history of postoperative outcomes after decompression or neurectomy in a pediatric population.

METHODS

A single-center retrospective case series was performed to evaluate factors predisposing children to refractory ON and the surgical efficacy of GON decompression or neurectomy. Six patients (mean age 15.0 ± 2.2 years) were identified for inclusion from October 2021 to October 2022. All patients had refractory ON as diagnosed by a pediatric neurologist. After medical therapy and repeated occipital nerve blocks failed, the patients were referred for GON decompression. Five patients had a history of trauma.

RESULTS

Six patients were identified and treated in our cohort, highlighting the infrequency of this pathology. All had at least one occipital nerve block, with 83% receiving varied relief. All underwent bilateral decompression or neurectomy of the GON and experienced relief, reporting improved visual analog scale scores (mean 8.3 ± 0.9 preoperatively to 1.0 ± 2.2 postoperatively, p = 0.0009). The patients were followed for an average of 10 months, and their mean number of medications decreased from 2.7 ± 0.5 preoperatively to 0.8 ± 0.7 postoperatively (p = 0.019). Each patient reported numbness or tingling in the GON distribution postoperatively, which spontaneously resolved over time. Two patients had recurrent pain in a delayed fashion.

CONCLUSIONS

GON decompression and neurectomy are efficacious treatments of refractory ON in the pediatric population.

摘要

目的

枕神经痛（ON）是一种罕见的头痛疾病，其特征为枕大神经（GON）、枕小神经或第三枕神经分布区域出现剧痛。ON通常与创伤性损伤相关，鉴于其发病率低且与其他小儿头痛疾病相似，有效的识别和诊断可能具有挑战性。虽然GON减压术在成人难治性疼痛治疗中已有详细描述，但儿科人群的数据较少，此前尚无关于ON的系列报道。本研究的主要目的是确定手术干预前小儿ON患者的特征，并描述儿科人群减压或神经切除术后的自然病史和术后结果。

方法

进行一项单中心回顾性病例系列研究，以评估导致儿童难治性ON的因素以及GON减压或神经切除术的手术疗效。2021年10月至2022年10月期间确定纳入6例患者（平均年龄15.0±2.2岁）。所有患者均经儿科神经科医生诊断为难治性ON。在药物治疗和反复枕神经阻滞失败后，患者被转诊接受GON减压术。5例患者有创伤史。

结果

我们的队列中确定并治疗了6例患者，突出了这种疾病的罕见性。所有患者至少接受过一次枕神经阻滞，83%的患者疼痛得到不同程度缓解。所有患者均接受了双侧GON减压或神经切除术，并获得缓解，视觉模拟量表评分改善（术前平均8.3±0.9，术后1.0±2.2，p=0.0009）。患者平均随访10个月，平均用药数量从术前的2.7±0.5降至术后的0.8±0.7（p=0.019）。每位患者术后均报告GON分布区域有麻木或刺痛感，随时间推移自发缓解。2例患者出现延迟性复发性疼痛。