Preoperative ultrasound evaluation for decompressive surgery for occipital neuralgia: Preliminary results of a case-control study

Area of Science:

• Neurology
• Medical Imaging
• Peripheral Nerve Disorders

Background:

• Occipital neuralgia pathogenesis remains unclear, though soft tissue alterations are implicated.
• Ultrasound (US) is increasingly used for peripheral nerve pathology assessment.

Purpose of the Study:

• To investigate soft tissue differences in the occipital region between occipital neuralgia patients and healthy controls using ultrasound.
• To evaluate ultrasound's utility in identifying pathological alterations and trigger points.

Main Methods:

• Retrospective observational study comparing 20 occipital neuralgia patients with 22 healthy volunteers.
• Ultrasound assessment of the greater occipital nerve (GON) and occipital artery (OA) morphology and cross-sectional area.
• Surgical documentation of soft tissue appearance and nerve-artery interaction.

Main Results:

• 16/20 patients showed ultrasound-detected pathological alterations of the GON, compared to 3/22 controls.
• Patients exhibited perineural fibrosis and OA morphological changes not typically seen in healthy subjects.
• Preoperative pain location correlated with the GON-OA contact point in 17/20 patients during surgery.

Conclusions:

• Ultrasound is a valuable tool for preoperative evaluation of occipital neuralgia, identifying soft tissue abnormalities and potential trigger points.
• Findings suggest a link between GON compression by the OA and occipital neuralgia symptoms.
• US can guide surgical planning and improve treatment outcomes for occipital neuralgia.