SURGICAL-TREATMENT OF GREATER OCCIPITAL NEURALGIA - AN APPRAISAL OF STRATEGIES

The surgical treatment of greater occipital neuralgia often involves d iagnostic anesthetic blockade, followed by chemical or surgical ablati on of the greater occipital nerve. The anatomy of this region was stud ied in microdissections of 2 cadaver specimens. The diagnosis and mana gement of a series of 5 patients with greater occipital neuralgia is d iscussed. Two patients were treated with atlanto-epistrophic ligament decompression of the C2 dorsal root ganglion and nerve; four patients had C2 ganglionotomy performed. All patients in this series had immedi ate complete relief of pain following surgery. Patients were followed for a mean of 24 months (range 7-33 months). One patient had a recurre nce of her original pain after 26 months following atlanto-epistrophic ligament decompression and required re-operation in the form of bilat eral C2 ganglionotomy. All patients experienced transient nausea and d izziness in the several days following surgery. One patient had an inc isional cerebrospinal fluid leak. Microsurgical C2 gangliotomy is advo cated as the preferred surgical treatment of greater occipital neuralg ia of idiopathic origin.