Long-term outcomes of C2 ganglion decompression for intractable occipital neuralgia

Abstract

Object: The aim of this study was to evaluate the safety and long-term clinical effect of second cervical (C2) ganglion decompression for intractable occipital neuralgia.

Methods: Patients were selected as following: headache was started from occiput; weak or no response to medication for more than 6 months; and temporary pain relief to C2 anesthetic blockade. Retrospective analysis was performed of 68 patients with medically refractory occipital neuralgia who underwent C2 ganglion decompression. Pre- and postoperative data regarding headache severity, medication use and postoperative complications were collected. Therapeutic success was defined as a pain relief by at least 50% without prescribed medication.

Results: Visual analog scale score was improved significantly between preoperative and last follow up period. All patients experienced immediate free from headache except two who recurred same symptoms within 7 days after the operation. One year later, excellent or good results were observed in 57 patients (83.9%), poor in 11 patients (16.1%). The long-term outcome in 5 year later was similar as 1 year-outcome. 47 of 68 patients (69.1%) obtained therapeutic success. Longer duration of headache (over than 13 year; p = .029) and presence of retro-orbital/frontal radiation (p = .040) were significantly associated with poor prognosis. There was no postoperative complication except transient occipital hypoesthesia in 11 patients (16.2%).

Conclusion: In the current study, C2 ganglion decompression provided durable, adequate pain relief with minimal complications in patients suffered from intractable occipital neuralgia. Longer duration of headache (> 13 year) and retro-orbital/frontal radiation of headache were poor prognostic factors in patients undergoing C2 ganglion decompression for intractable occipital neuralgia. Further study is mandated to manage pain recurrence associated with longstanding nerve injury.