Skip to main content

Long-term outcome and prognostic factors after C2 ganglion decompression in 68 consecutive patients with intractable occipital neuralgia

Acta Neurochirurgica volume 157, pages 85–92 (2015)Cite this article

Abstract

Background

Occipital neuralgia is a rare cause of severe headache characterized by paroxysmal shooting or stabbing pain in the distribution of the greater occipital or lesser occipital nerve. In cases of intractable occipital neuralgia, a definite cause has not been uncovered, so various types of treatment have been applied. The aim of this study is to evaluate the prognostic factors, safety, and long-term clinical efficacy of second cervical (C2) ganglion decompression for intractable occipital neuralgia.

Methods

Retrospective analysis was performed in 68 patients with medically refractory occipital neuralgia who underwent C2 ganglion decompression. Factors based on patients’ demography, pre- and postoperative headache severity/characteristics, medication use, and postoperative complications were investigated. Therapeutic success was defined as pain relief by at least 50 % without ongoing medication.

Results

The visual analog scale (VAS) score was significantly reduced between the preoperative and most recent follow-up period. One year later, excellent or good results were achieved in 57 patients (83.9 %), but poor in 11 patients (16.1 %). The long-term outcome after 5 years was only slightly less than the 1-year outcome; 47 of the 68 patients (69.1 %) obtained therapeutic success. Longer duration of headache (over 13 years; p = 0.029) and presence of retro-orbital/frontal radiation (p = 0.040) were significantly associated with poor prognosis.

Conclusions

In the current study, C2 ganglion decompression provided durable, adequate pain relief with minimal complications in patients suffering from intractable occipital neuralgia. Due to the minimally invasive and nondestructive nature of this surgical procedure, C2 ganglion decompression is recommended as an initial surgical treatment option for intractable occipital neuralgia before attempting occipital nerve stimulation. However, further study is required to manage the pain recurrence associated with longstanding nerve injury.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Acar F, Miller J, Golshani KJ, Israel ZH, McCartney S, Burchiel KJ (2008) Pain Relief after cervical ganglionectomy (C2 and C3) for the treatment of medically intractable occipital neuralgia. Stereotact Funct Neurosurg 86:106–112

    PubMed  Article  Google Scholar 

  2. Afridi SK, Shields KG, Bhola R, Goadsby PJ (2006) Greater occipital nerve injection in primary headache syndromes—prolonged effects from a single injection. Pain 122:126–129

    CAS  PubMed  Article  Google Scholar 

  3. Bovim G, Berg R, Dale LG (1992) Cervicogenic headache: Anesthetic blockades of cervical nerves (C2-C5) and facet joint (C2/C3). Pain 49:315–320

    CAS  PubMed  Article  Google Scholar 

  4. Campbell JN, Meyer RA (2006) Mechanisms of neuropathic pain. Neuron 52:77–92

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  5. Dubuisson D (1995) Treatment of occipital neuralgia by partial posterior rhizotomy at C1–3. J Neurosurg 82:581–586

    CAS  PubMed  Article  Google Scholar 

  6. Ducic I, Hartmann EC, Larson EE (2009) Indications and outcomes for surgical treatment of patients with chronic migraine headaches caused by occipital neuralgia. Plast Reconstr Surg 123:1453–1461

    CAS  PubMed  Article  Google Scholar 

  7. Ehni G, Benner B (1984) Occipital neuralgia and the C1-2 arthrosis syndrome. J Neurosurg 61:961–965

    CAS  PubMed  Article  Google Scholar 

  8. Gille O, Lavignolle B, Vital JM (2004) Surgical treatment of greater occipital neuralgia by neurolysis of the greater occipital nerve and sectioning of the inferior oblique muscle. Spine (Phila Pa 1976) 29:828–832

  9. Headache Classification Subcommittee of the International Headache Society (2004) The International Classification of Headache Disorders: 2nd edition. Cephalalgia 24(Suppl 1):9–160

    Google Scholar 

  10. Horowitz MB, Yonas H (1993) Occipital neuralgia treated by intradural dorsal nerve root sectionning. Cephalalgia 13:354–360

    CAS  PubMed  Article  Google Scholar 

  11. Jansen J, Bardosi A, Hildebrandt J, Lücke A (1989) Cervicogenic, hemicranial attacks associated with vascular irritation or compression of the cervical nerve root C2: clinical manifestations and morphological findings. Pain 39:203–212

    CAS  PubMed  Article  Google Scholar 

  12. Kuhn WF, Kuhn SC, Gilberstadt H (1997) Occipital neuralgias: clinical recognition of a complicated headache. A case series and literature review. J Orofac Pain 11:158–165

    CAS  PubMed  Google Scholar 

  13. Kupur N, Kamel IR, Herlich A (2003) Oral and craniofacial pain: diagnosis, pathophysiology, and treatment. Int Anesthesiol Clin 41:115–150

    Article  Google Scholar 

  14. Lozano AM, Vanderlinden G, Bachoo R, Rothbart P (1998) Microsurgical C-2 ganglionectomy for chronic intractable occipital pain. J Neurosurg 89:359–365

    CAS  PubMed  Article  Google Scholar 

  15. Martelletti P, van Suijlekom H (2004) Cervicogenic headache: Practical approaches to therapy. CNS Drugs 18:793–805

    PubMed  Article  Google Scholar 

  16. Navani A, Mahajan G, Kreis P, Fishman SM (2006) A case of pulsed radiofrequency lesioning for occipital neuralgia. Pain Med 7:453–456

    PubMed  Article  Google Scholar 

  17. Pagni CA, Lanotte M, Canavero S (1993) How frequent is anesthesia dolorosa following spinal posterior rhizotomy? A retrospective analysis of fifteen patients. Pain 54:323–337

    CAS  PubMed  Article  Google Scholar 

  18. Pikus HJ, Phillips JM (1996) Outcome of surgical decompression of the second cervical root for cervicogenic headache. Neurosurgery 39:63–71

    CAS  PubMed  Article  Google Scholar 

  19. Pisapia JM, Bhowmick DA, Farber RE, Zager EL (2012) Salvage C2 ganglionectomy after C2 nerve root decompression provides similar pain relief as a single surgical procedure for intractable occipital neuralgia. World Neurosurg 77:362–369

    PubMed  Article  Google Scholar 

  20. Poletti CE, Sweet WH (1990) Entrapment of the C2 root and ganglion by the atlanto-apistrophic ligament: Clinical syndrome and surgical anatomy. Neurosurgery 27:288–291

    CAS  PubMed  Article  Google Scholar 

  21. Schwedt TJ, Dodick DW, Hentz J, Trentman TL, Zimmerman RS (2007) Occipital nerve stimulation for chronic headache—long-term safety and efficacy. Cephalalgia 27:153–157

    CAS  PubMed  Article  Google Scholar 

  22. Sharma RR, Devadas RV, Pawar SJ, Lad SD, Mahapatra AK (2005) Current status of peripheral neurectomy for occipital neuralgia. Neurosurg Q 15:232–238

    Article  Google Scholar 

  23. Shin JH, Song HK, Lee JH, Kim WK, Chu MK (2007) Paroxysmal stabbing headache in the multiple dermatomes of the head and neck: a variant of primary stabbing headache or occipital neuralgia? Cephalalgia 27:1101–1108

    CAS  PubMed  Article  Google Scholar 

  24. Sjaastad O, Fredriksen TA, Stolt-Nielsen A (1986) Cervicogenic headache, C2 rhizopathy, and occipital neuralgia: A connection? Cephalalgia 6:189–195

    CAS  PubMed  Article  Google Scholar 

  25. Slavin KV, Nersesyan H, Wess C (2006) Peripheral neurostimulation for treatment of intractable occipital neuralgia. Neurosurgery 58:112–119

    PubMed  Article  Google Scholar 

  26. Stechison MT, Mullin BB (1994) Surgical treatment of greater occipital neuralgia: An appraisal of strategies. Acta Neurochir (Wien) 131:236–240

    CAS  Article  Google Scholar 

  27. Taylor M, Silva S, Cottrell C (2008) Botulinum toxin type-A (BOTOX) in the treatment of occipital neuralgia: a pilot study. Headache 48:1476–1481

    PubMed  Article  Google Scholar 

  28. Van Zundert J, Lamé IE, de Louw A, Jansen J, Kessels F, Patijn J, van Kleef M (2003) Percutaneous pulsed radiofrequency treatment of the cervical dorsal root ganglion in the treatment of chronic cervical pain syndromes: a clinical audit. Neuromodulation 6:6–14

    PubMed  Article  Google Scholar 

  29. Vanelderen P, Lataster A, Levy R, Mekhail N, van Kleef M, Van Zundert J (2010) Occipital neuralgia. Pain Pract 10:137–144

    PubMed  Article  Google Scholar 

  30. Wang MY, Levi AD (2002) Ganglionectomy of C-2 for the treatment of medically refractory occipital neuralgia. Neurosurg Focus 12:1–3

    Article  Google Scholar 

  31. Weiner RL (2011) Subcutaneous occipital region stimulation for intractable headache syndromes. Prog Neurol Surg 24:77–85

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

The authors thank Rayeon Kim, M.F.A., from Ewha Womans University for medical illustration.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Hanyang University Medical Center, 17 Haengdang-dong, Seongdong-gu, 133-792, Seoul, Korea

    Kyu-Sun Choi, Yong Ko, Young-Soo Kim & Hyeong-Joong Yi

Authors
  1. Kyu-Sun Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yong Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Young-Soo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyeong-Joong Yi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong Ko.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Choi, KS., Ko, Y., Kim, YS. et al. Long-term outcome and prognostic factors after C2 ganglion decompression in 68 consecutive patients with intractable occipital neuralgia. Acta Neurochir 157, 85–92 (2015). https://doi.org/10.1007/s00701-014-2255-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-014-2255-x

Keywords

  • Headache
  • Neuralgia
  • Pain, intractable
  • Decompression, surgical
  • Treatment outcome