Endoscopic-Assisted Extended Nerve Decompression with Radical Artery Elimination Yields Superior Relief for Refractory Occipital Migraines.

BACKGROUND

Surgical decompression of the greater occipital nerve (GON) is a recognized treatment for occipital migraines that are resistant to medical management. Recent evidence suggests that vascular compression by the occipital artery (OA) contributes to occipital migraine pathophysiology. This study compared postoperative outcomes between endoscopic-assisted radical GON decompression along its entire course with complete OA elimination and standard open GON decompression with limited proximal OA elimination.

METHODS

A retrospective review was performed on 85 patients who underwent endoscopic-assisted (n=74) or open GON decompression (n=11). Outcomes included changes in migraine headache index (MHI), migraine intensity, frequency, and duration. Cox regression analysis evaluated the probability of achieving a 90% reduction in migraine frequency and MHI over 35 months.

RESULTS

Both surgical techniques resulted in significant improvements in MHI, intensity, duration, and frequency (p<0.01 for all measures). The endoscopic-assisted group demonstrated greater reductions in MHI (-182.11 vs. -152.85, p=0.17), frequency (-20.90 vs. -15.45, p=0.08), and intensity (-5.44 vs. -3.00, p<0.001) compared to the open group. Complete migraine resolution rates were also significantly higher in the endoscopic group (69.8% vs. 45.0%, p=0.04). Cox regression analysis showed that endoscopic-assisted decompression was associated with a significantly higher likelihood of maintaining a 90% reduction in migraine frequency and MHI over 36 months.

CONCLUSIONS

Endoscopic-assisted GON decompression with complete OA resection is more effective than open decompression in achieving and sustaining occipital migraine relief. These findings underscore the key role of vascular compression in migraine pathogenesis and highlight endoscopic-assisted decompression as the preferred surgical approach.