Surgical management of pediatric occipital neuralgia: a single-center experience of an uncommon pathology
Lance M. Villeneuve
Lance M. VilleneuveDepartment of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children’s Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and
Nangorgo J. CoulibalyDepartment of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children’s Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and
Syed M. RazaDepartment of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children’s Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and
Brittany PoinsonDepartment of Pediatric Neurology, Oklahoma Children’s Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Deepti ChruscielDepartment of Pediatric Neurology, Oklahoma Children’s Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Virendra R. DesaiDepartment of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children’s Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and
Occipital neuralgia (ON) is a rare headache disorder characterized by sharp pain in the distribution of the greater occipital nerve (GON), lesser occipital nerve, or third occipital nerve. ON is commonly associated with traumatic injury, and effective identification and diagnosis can be difficult given the infrequent presentation and similarities to other pediatric headache disorders. While GON decompression has been well described in adults for refractory pain, there is a paucity of data in the pediatric population, with no previously published series on ON. The primary aim of this study was to identify the characteristics of pediatric patients with ON prior to surgical intervention and to describe the natural history of postoperative outcomes after decompression or neurectomy in a pediatric population.
开云体育世界杯赔率
A single-center retrospective case series was performed to evaluate factors predisposing children to refractory ON and the surgical efficacy of GON decompression or neurectomy. Six patients (mean age 15.0 ± 2.2 years) were identified for inclusion from October 2021 to October 2022. All patients had refractory ON as diagnosed by a pediatric neurologist. After medical therapy and repeated occipital nerve blocks failed, the patients were referred for GON decompression. Five patients had a history of trauma.
RESULTS
Six patients were identified and treated in our cohort, highlighting the infrequency of this pathology. All had at least one occipital nerve block, with 83% receiving varied relief. All underwent bilateral decompression or neurectomy of the GON and experienced relief, reporting improved visual analog scale scores (mean 8.3 ± 0.9 preoperatively to 1.0 ± 2.2 postoperatively, p = 0.0009). The patients were followed for an average of 10 months, and their mean number of medications decreased from 2.7 ± 0.5 preoperatively to 0.8 ± 0.7 postoperatively (p = 0.019). Each patient reported numbness or tingling in the GON distribution postoperatively, which spontaneously resolved over time. Two patients had recurrent pain in a delayed fashion.
CONCLUSIONS
GON decompression and neurectomy are efficacious treatments of refractory ON in the pediatric population.
CorrespondenceLance M. Villeneuve: Oklahoma Children’s Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, OK.lance-villeneuve@ouhsc.edu.
INCLUDE WHEN CITINGPublished online July 28, 2023; DOI: 10.3171/2023.5.PEDS22554.
DisclosuresThe authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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