Lozano A M, Vanderlinden G, Bachoo R, Rothbart P
The Toronto Hospital, and Department of Surgery, University of Toronto, Ontario, Canada.
J Neurosurg. 1998 Sep;89(3):359-65. doi: 10.3171/jns.1998.89.3.0359.
The authors evaluated the effectiveness of microsurgical C-2 ganglionectomy in 39 patients with medically refractory chronic occipital pain. In this procedure the neurons transmitting sensory inputs from the occiput are removed and, unlike peripheral nerve ablation, axonal regeneration is not possible.
The patients in this series had symptoms for 1 to 43 years. In 22 patients the occipital pain was caused by trauma; in 17 patients the pain was spontaneous. Pain relief failed in 17 patients who had undergone a previous occipital neurectomy or C-2 rhizolysis. Twenty-three patients experienced pain that was described as shocklike, electric, shooting, jabbing, stabbing, sharp, or exploding (Group I). Eight patients described their pain as dull, pounding, aching, throbbing, or pressurelike (Group II). The patients underwent unilateral or bilateral C-2 open microsurgical ganglionectomies. The postoperative follow-up period ranged from 19 to 48 months. Nineteen patients experienced an excellent result (> 90% reduction in pain). Pain caused by trauma or that described using Group I terms responded best to ganglionectomy (80% good or excellent response). In contrast, the majority of the patients with nontraumatic pain or those described using Group II descriptors did not achieve favorable results.
The authors conclude that: 1) patients who suffer from chronic occipital pain after having sustained injury obtain worthwhile benefit from microsurgical C-2 ganglionectomy; 2) patients suffering from migraine, tension, and vascular headaches involving the occipital area are most often not helped by this operation; and 3) terms such as "shock," "electric," "shooting," "jabbing," and "sharp" used to describe occipital pain predict a favorable pain outcome following a C-2 ganglionectomy.
作者评估了显微外科C-2神经节切除术对39例药物治疗无效的慢性枕部疼痛患者的疗效。在此手术中，传递来自枕部感觉输入的神经元被切除，与周围神经消融不同的是，轴突再生是不可能的。
本系列患者的症状持续1至43年。22例患者的枕部疼痛由创伤引起；17例患者的疼痛为自发性。17例曾接受过枕部神经切除术或C-2神经根松解术的患者疼痛缓解失败。23例患者经历的疼痛被描述为电击样、电灼样、枪击样、戳刺样、刺痛样、锐痛样或爆裂样（第一组）。8例患者将他们的疼痛描述为钝痛、搏动性疼痛、酸痛、跳痛或压迫样疼痛（第二组）。患者接受了单侧或双侧C-2开放式显微神经节切除术。术后随访期为19至48个月。19例患者取得了优异的效果（疼痛减轻>90%）。由创伤引起的疼痛或用第一组术语描述的疼痛对神经节切除术反应最佳（80%良好或优异反应）。相比之下，大多数非创伤性疼痛患者或用第二组描述词描述的患者未取得良好效果。
作者得出结论：1）遭受持续性损伤后患有慢性枕部疼痛的患者从显微外科C-2神经节切除术中获得了有价值的益处；2）患有偏头痛、紧张性头痛和涉及枕部区域的血管性头痛的患者通常无法从该手术中得到帮助；3）用于描述枕部疼痛的“电击样”“电灼样”“枪击样”“戳刺样”和“锐痛样”等术语预示着C-2神经节切除术后良好的疼痛结局。
