Surgical therapy of occipital (Arnold) neuralgia: A case series

Raposio, Giorgio; Raposio, Edoardo

doi:10.1016/j.amsu.2022.104237

Cited by 7 publications

(5 citation statements)

References 28 publications

(24 reference statements)

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“…By releasing the pressure on the affected nerves, nerve decompression surgery can alleviate the symptoms of chronic migraines. Nerve treatment decompression surgery has been used to treat various types of chronic headaches, including occipital neuralgia [9][10][11][12]. Occipital neuralgia is a neurological condition characterized by paroxysmal, shooting pain centered over the posterior scalp including the occipital nerve region.…”

Section: Discussionmentioning

confidence: 99%

Case series and literature review of up-to-date surgical management of occipital neuralgia

Lee,

Park,

Jeong

2024

Arch Plast Surg

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Nerve decompression is an emerging surgical treatment option for patients with occipital neuralgia. However, limited research is available on the efficacy of this treatment in South Korea. This retrospective study evaluates the efficacy of nerve decompression surgery in patients with chronic migraines, specifically focusing on occipital neuralgia, in South Korea. Between January 2019 and December 2022, six patients diagnosed with occipital neuralgia, who had not responded to conservative treatments, underwent nerve decompression surgery. This procedure, performed under local anesthesia, involved decompression of the greater and/or lesser occipital nerves. Patient data was analyzed for headache frequency and intensity (using the Numeric Rating Scale [NRS]) and the decrease in oral medications needed post-surgery. Results showed significant improvement in headache symptoms post-surgery, with the average preoperative NRS score of 7.9 dropping to 3.7 postoperatively. Additionally, the average number of medications used decreased from 3.2 to 1.3. No significant surgical complications were reported. The study highlights the potential of nerve decompression as an effective treatment for occipital neuralgia, particularly in cases resistant to traditional medical management.

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Section: Discussionmentioning

confidence: 99%

Case series and literature review of up-to-date surgical management of occipital neuralgia

Lee,

Park,

Jeong

2024

Arch Plast Surg

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Section: Techniquementioning

confidence: 99%

“…The aim of this work was to describe a semeiological maneuver we introduced as an aid in the preoperative screening of these patients, based on clinical experience gained over the past 12 years. [25][26][27][28][29][30] First, the patient is asked to flex the head, in such a way as to bring the chin as close as possible to the left shoulder. At this point, we imagine an oblique line, near the superior nuchal line, which ideally joins the inion with the inferior apex of the right mastoid process (Fig.…”

mentioning

confidence: 99%

Active Occipital Motion with Digipressure as Preoperative Screening in Migraine Surgery

Raposio,

Baldelli

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: Modern surgical therapy of chronic headaches/migraines is essentially based on the release/neurolysis of extracranial nerves, which, when compressed or inflamed, act as trigger points and, as such, trigger headache attacks. The aim of this article was to describe a novel maneuver we use as an aid in the preoperative planning of occipital trigger sites. Methods: In the period of January 2021–September 2023, we operated on 32 patients (11 men, 21 women, age range: 26–68 years), who underwent migraine surgery for occipital trigger point release. All patients were evaluated using the described preoperative maneuver. In a dedicated card, the levels of tenderness at each point were marked accordingly, differentiating them by intensity as nothing (−), mild (+), medium (++), or high (+++). Patients were then operated on at the points corresponding only to the ++ and +++ signs. Results: At 6-month follow-up, we observed significant improvement (>50%) in 29 patients (91%), with complete recovery in 25 patients (78%). Conclusions: In our experience, the maneuver described, in addition to being very simple, has been shown to have good sensitivity and reproducibility. We therefore recommend its use, especially for those surgeons beginning their practice in this particular area of plastic surgery.

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“… 3 If the conservative therapeutics are not effective, minimally invasive intervention treatment can be chosen, and surgical interventions could be reserved for select patient populations who have failed all other conservative and minimally invasive options. 4 , 5 Cervical 2 dorsal root ganglion (C2 DRG), third occipital nerve (TON) and C3 medial branch block or pulsed radiofrequency (PRF), are optional options for minimally invasive treatment. 6 Traditionally, these interventional procedures are usually carried on under the guidance of C-arm or Computed Tomography (CT), which cannot directly render real-time vision of the needle tip for interventionalists during operative procedures, and the risk of spinal cord and vertebral artery injury cannot be completely avoided.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, we consider that the risk of spinal cord injury still cannot be completely avoided, by using its puncture target and needle insertion method. Furthermore, it is worth mentioning that, for the existence of neural interconnections and multiple nerves involved in CEH, 4,12 the effect of single nerve modulation was often unsatisfactory, and modulation of multiple nerves was required. 13 Here, we introduced the technical considerations of an ultrasound-guided "Three in One" approach plus interfascial plane (IFP) blocks for the treatment of CEH.…”

Section: Introductionmentioning

confidence: 99%

A Novel Ultrasound-Guided “Three in One” Approach Plus Interfascial Plane Blocks for the Treatment of Cervicogenic Headache

Ma,

Maimaitimin,

Wang

2024

LRA

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Objective Cervicogenic headache (CEH) is a condition resulting from upper cervical spine dysfunction and associated structural and soft tissue abnormalities, significantly impacting patients’ quality of life. To acquire better therapeutic results, we presented a novel ultrasound-guided “three in one” approach plus interfascial plane (IFP) blocks for the treatment of CEH. This approach allows for the modulation of C2 dorsal root ganglion (DRG), third occipital nerve (TON), and C3 medial branch with one-point puncture. Additionally, it allows for IFP blocks between the upper neck and occipital muscles within the same scanning plane. Patients and Methods We evaluated patients diagnosed with CEH from July 2021 to December 2022 in our pain clinic. We included those who did not respond to conservative treatment and single occipital nerve block, therefore received nerve block or pulsed radiofrequency (PRF) using the “Three in One” approach plus IFP blocks. The accuracy of the ultrasound-guided C2 DRG puncture procedures was confirmed through fluoroscopy with C-arm and the sensory testing of PRF. The therapeutic effect of these interventions was assessed using the numerical rating scale (NRS) scores during telephone follow-ups at 1, 3, and 6 months. Results Utilizing the “Three in One” approach, a total of 5 patients diagnosed with CEH underwent nerve block plus IFP blocks, while 2 patients underwent PRF plus IFP blocks. Employing ultrasound-guided C2 DRG puncture procedures, the needle tip’s correct placement was confirmed through both fluoroscopy and sensory testing of PRF. Notably, none of the cases experienced any complications associated with the approach. Subsequent follow-up assessments revealed an improvement in the NRS scores for CEH in all patients. Conclusion The ultrasound-guided “Three in One” approach plus IFP blocks may be a potential effective method for the treatment of CEH.

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Surgical therapy of occipital (Arnold) neuralgia: A case series

Cited by 7 publications

References 28 publications

Case series and literature review of up-to-date surgical management of occipital neuralgia

Case series and literature review of up-to-date surgical management of occipital neuralgia

Active Occipital Motion with Digipressure as Preoperative Screening in Migraine Surgery

A Novel Ultrasound-Guided “Three in One” Approach Plus Interfascial Plane Blocks for the Treatment of Cervicogenic Headache

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