TREATMENT OF OCCIPITAL NEURALGIA BY PARTIAL POSTERIOR RHIZOTOMY AT C1-3

To minimize the sensory loss associated with intradural posterior rhiz otomy for medically refractory occipital neuralgia, partial sectioning of the upper cervical posterior rootlets was performed in 11 patients . The ventrolateral aspect of each posterior rootlet from C-1 to the u pper portion of C-3 was divided at the root entry zone. In three patie nts with bilateral neuralgia, the procedure was performed on both side s, for a total of 14 partial rhizotomy procedures in the 11 patients. This resulted in satisfactory preservation of scalp sensation in all c ases. Pain within the territory of the greater occipital nerve was con sistently reduced or abolished by this procedure. The overall degree o f pain relief was rated good or excellent after 10 of the 14 procedure s. The other four procedures alleviated pain in the territory of the g reater occipital nerve, but the results were marred by persistent peri orbital or temporal pain. Two patients subsequently underwent complete C1-3 posterior rhizotomy without further improvement. Although partia l posterior rhizotomy at C1-3 did not always relieve pain in the perio rbital and temporal regions, this procedure did provide consistent lon gterm relief of severe occipital pain with minimal risk of postoperati ve vertigo, scalp anesthesia, or deafferentation syndrome.