The aim of the study was to evaluate the effectiveness of greater occipital nerve decompression for the management of occipital neuralgia. Eleven patients of medical refractory occipital neuralgia were enrolled in the study. Local anaesthetic blocks were used for confirming diagnosis. All of them underwent surgical decompression of greater occipital nerve at the level of semispinalis capitis and trapezial tunnel. A pre and postoperative questionnaire was used to compare the severity of pain and number of pain episodes/month. Mean pain episodes reported by patients before surgery were 17.1 ± 5.63 episodes per month. This reduced to 4.1 ± 3.51 episodes per month (P < 0.0036) postsurgery. The mean intensity of pain also reduced from a preoperative 7.18 ± 1.33 to a postoperative of 1.73 ± 1.95 (P < 0.0033). Three patients reported complete elimination of pain after surgery while 6 patients reported significant relief of their symptoms. Only 2 patients failed to notice any significant improvement. The mean follow-up period was 12.45 ± 1.29 months. Surgical decompression of greater occipital nerve is a simple and viable treatment modality for the management of occipital neuralgia.
Migraine surgery has been recently reported as an alternative to medical management to provide long-term relief in migraine sufferers. A prospective study was designed wherein patients diagnosed with migraine were screened for surgery by injecting botulinum toxin type A at the primary trigger site. Surgery consisted of corrugator supercilii muscle resection to decompress supra-trochlear and supra-orbital nerves with avulsion of zygomaticotemporal branch of trigeminal nerve. Using pre and postsurgery questionnaires, information regarding the degree of reduction of migraines with regard to severity and frequency; and surgical site problems was acquired. Thirty patients volunteered for migraine surgery. Mean migraine headaches reduced from 15.2 ± 6.3 episodes per month to 1.9 ± 2.4 episodes per month (P < 0.0001) postsurgery. The mean intensity of migraine headache also reduced from a preoperative 7.3 ± 3.5 to a postoperative of 1.3 ± 1.4 (P < 0.0001). Fourteen (46.7%) patients reported complete elimination of migraine after surgery while an equal number reported significant relief of symptoms. Two (6.6%) patients failed to notice any significant improvement after surgery. The mean follow-up period was 11.1 ± 2 months with no major surgical complications. Results of the authors' study confirm prior published results that surgical treatment of migraine is a reality. Surgeons can easily incorporate this simple surgical procedure in their armamentarium to offer relief to numerous migraine patients.
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