Percutaneous Full-Endoscopic C2 Ganglionectomy for the Treatment of Intractable Occipital Neuralgia: Technical Note

Abstract

BACKGROUND The C-2 dorsal root ganglionectomy procedure can provide effective treatment for intractable occipital neuralgia (ON). However, the traditional microsurgery of C2 ganglionectomy needs a wide incision and significant paraspinous muscle dissection for adequate visualization. The indications of endoscopic spine surgery are ever expanding, with the development of endoscopic armamentaria and technological innovations. OBJECTIVE To validate the feasibility of the approach and describe several operative nuances based on the authors’ experience. In this paper, the authors describe a patient with intractable ON who was successfully treated with a percutaneous full-endoscopic C2 ganglionectomy. METHODS We describe the case of an 83-yr-old female with a 2-yr history of left ON who did not respond to a series of treatments, including physical therapy, drug therapy, injection therapy, and radiofrequency therapy. After careful examination, we performed a percutaneous, full-endoscopic left C2 ganglionectomy. RESULTS The patient was successfully treated with a percutaneous full-endoscopic ganglionectomy. Afterwards, her intractable and constant pain was relieved. There was no cerebrospinal fluid leakage, incision infection, neck deformity, or other complications. CONCLUSION C2 ganglionectomy can be accomplished successfully using a full-endoscopic uniportal surgical technique under continuous irrigation, which has the advantages of excellent illumination and visualization, reduced surgery-related trauma, and reduced bleeding.

Percutaneous full-endoscopic uniportal decompression for the treatment of symptomatic idiopathic lumbar spinal epidural lipomatosis: Technical note

“…During the past three decades, percutaneous endoscopic spine surgery has evolved dramatically with the development of endoscopic equipment and techniques. As a result, the indications of endoscopic spine surgery are ever expanding, from the initial lumbar disc disease to other types of pathologies located in the whole spine column ( 4 ). The obvious advantages of percutaneous working-channel endoscopic spine surgery are as follows: reduction of the surgical corridor, avoiding muscular dissection, reduction of bony resection to prevent iatrogenic instability, close observation to obtain excellent visualization, and reduction of bleeding under water perfusion pressure ( 4 ).…”

“…As a result, the indications of endoscopic spine surgery are ever expanding, from the initial lumbar disc disease to other types of pathologies located in the whole spine column ( 4 ). The obvious advantages of percutaneous working-channel endoscopic spine surgery are as follows: reduction of the surgical corridor, avoiding muscular dissection, reduction of bony resection to prevent iatrogenic instability, close observation to obtain excellent visualization, and reduction of bleeding under water perfusion pressure ( 4 ). In the operation of this case, we used Delta endoscopic surgical system with a larger manipulation channel (diameter of 1 cm) than the previous traditional endoscopy ( Figure 3 ).…”

“…The outer working cannula can be inserted toward the contralateral side using sub-spinous process space. The camera’s eye with 15 view angles can be put closer to the opposite side lesion, providing high-definition images on a video monitor for the operator ( 4 , 22 ). Therefore, it makes the removal of excessive adipose tissue safer and easier, facilitating the reduction of the possibility of dura tear and neural damage.…”

“…Percutaneous endoscopic spine surgery has been evolving rapidly these years with the development of endoscopic philosophy, technology, and equipment ( 1 , 2 ). Consequently, the indications of endoscopic spine surgery are ever expanding, from the initial lumbar intervertebral disk disease to other types of pathologies located in the whole spinal column ( 3 , 4 ). The obvious advantages of working-channel endoscopic spinal surgery include the reduction of the surgical corridor, avoiding soft tissue and muscular stripping, minimizing bony resection, as well as obtaining excellent visualization ( 1 , 2 , 4 ).…”

Percutaneous full-endoscopic C2 ganglionectomy for the treatment of intractable occipital neuralgia: technical feasibility and preliminary results

“…It is one of the reasons why this technique is not frequently employed by surgeons. Percutaneous full-endoscopic C2 ganglionectomy has been developed to overcome these shortcomings [7], in which C2 ganglionectomy can be executed through the slim working channel under continuous irrigation (Fig. 1).…”