Minimally invasive, nerve and muscle sparing surgical decompression for occipital neuralgia.

BACKGROUND: Occipital Neuralgia (ON) is a well-defined type of headache, whose treatment algorithm is still debated across medical specialties. From the analysis of the literature, it appears that surgical decompression of the occipital nerves is the most effective invasive approach to improve the quality of life of patients suffering from ON refractory to medications. We describe here a minimally invasive nerve and muscle sparing technique to decompress the occipital nerves.

METHODS: The results in terms of reduction of migraine days / month, use of medications, pain evaluation, and decrease in migraine headache index (MHI) were analyzed via a retrospective chart review of 87 patients who underwent nerve and muscle sparing surgical decompression of the greater and lesser occipital nerves mono- or bi-lateral in our institution and were followed up for at least 12 months. The surgical technique is described in detail.

RESULTS: Surgical decompression significantly reduced ON burden (at least 50% improvement) in 91% of patients, with 45% reporting a complete remission of occipital pain. Days with pain per month decreased by 80%, chronic background pain intensity decreased by 81% and pain intensity during crisis decreased by 76%. Accordingly, drug usage dropped by about 70%. Only minor complications were reported in 4 patients.

CONCLUSION: The described technique could contribute to further attest surgical decompression as the first option among the invasive approaches to treat ON. Results corroborates previous findings adding a less invasive, nerve and muscle sparing approach.