Korean J Pain.  2011 Mar;24(1):48-52. 10.3344/kjp.2011.24.1.48.

A Case of Occipital Neuralgia in the Greater and Lesser Occipital Nerves Treated with Neurectomy by Using Transcranial Doppler Sonography: Technical Aspects

• Jung SJ
• Moon SK
• Kim TY
• Eom KS

• KMID: 2278097
• DOI: http://doi.org/10.3344/kjp.2011.24.1.48

Abstract

Occipital neuralgia is usually defined as paroxysmal stabbing pain in the greater or lesser occipital nerve (GON or LON) distribution. In occipital neuralgia patients, surgical considerations are carefully taken into account if medical management is ineffective. However, identification of the occipital artery by palpation in patients with thick necks or small occipital arteries can be technically difficult. Therefore, we established a new technique using transcranial Doppler (TCD) sonography for more accurate and rapid identification. The patient was a 64-year-old man who had undergone C1-C3 screw fixation and presented with intractable stabbing pain in the bilateral GON and LON distributions. In cases in which pain management was performed using medication, physical therapy, nerve block, or radiofrequency thermocoagulation, substantial pain relief was not consistently achieved, and recurrence of pain was reported. Therefore, we performed occipital neurectomy of the bilateral GON and LON by using TCD sonography, which helped detect the greater occipital artery easily. After the operation, the patient's headache disappeared gradually, although he had discontinued all medication except antidepressants. We believe that this new technique of occipital neurectomy via a small skin incision performed using TCD sonography is easy and reliable, has a short operative time, and provides rapid pain relief.

Keyword

neurectomy; occipital neuralgia; transcranial Doppler sonography

MeSH Terms

Antidepressive Agents
Arteries
Electrocoagulation
Headache
Humans
Middle Aged
Neck
Nerve Block
Neuralgia
Operative Time
Pain Management
Palpation
Recurrence
Skin
Ultrasonography, Doppler, Transcranial
Antidepressive Agents

Figure

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  Fig. 1 (A) Computed tomography (CT) scan of the cervical spine with the bone-window setting showing a burst fracture of C2. (B) Postoperative plain lateral radiography showing C1-C3 screw fixation.

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  Fig. 2 (A) Pain distribution in the patient in the distribution of the bilateral greater occipital nerve and lesser occipital nerve in the occipital area above the superior nuchal line. (B) The pulsation of occipital artery can be detected by using a portable transcranial Doppler (TCD) sonography machine: an 8-MHz probe is manipulated along the superior nuchal ridge until the blood flow in the occipital artery is audible and visible. GON: greater occipital nerve, OA: occipital artery.

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  Fig. 3 Intraoperative photograph obtained before neurectomy showing right greater occipital nerve just medial to the right occipital artery. Rt. GON: right greater occipital nerve, Rt. OA: right occipital artery.

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