Surgical treatment of greater occipital neuralgia: an appraisal of strategies.

The surgical treatment of greater occipital neuralgia often involves diagnostic anesthetic blockade, followed by chemical or surgical ablation of the greater occipital nerve. The anatomy of this region was studied in microdissections of 2 cadaver specimens. The diagnosis and management of a series of 5 patients with greater occipital neuralgia is discussed. Two patients were treated with atlanto-epistrophic ligament decompression of the C2 dorsal root ganglion and nerve; four patients had C2 ganglionotomy performed. All patients in this series had immediate complete relief of pain following surgery. Patients were followed for a mean of 24 months (range 7-33 months). One patient had a recurrence of her original pain after 26 months following atlanto-epistrophic ligament decompression and required re-operation in the form of bilateral C2 ganglionotomy. All patients experienced transient nausea and dizziness in the several days following surgery. One patient had an incisional cerebrospinal fluid leak. Microsurgical C2 gangliotomy is advocated as the preferred surgical treatment of greater occipital neuralgia of idiopathic origin.