title: Long-term outcome and prognostic factors after C2 ganglion decompression in 68 consecutive patients with intractable occipital neuralgia.
abstract: BACKGROUND
  Occipital neuralgia is a rare cause of severe headache characterized by paroxysmal shooting or stabbing pain in the distribution of the greater occipital or lesser occipital nerve. In cases of intractable occipital neuralgia, a definite cause has not been uncovered, so various types of treatment have been applied. The aim of this study is to evaluate the prognostic factors, safety, and long-term clinical efficacy of second cervical (C2) ganglion decompression for intractable occipital neuralgia.
  
  
  METHODS
  Retrospective analysis was performed in 68 patients with medically refractory occipital neuralgia who underwent C2 ganglion decompression. Factors based on patients' demography, pre- and postoperative headache severity/characteristics, medication use, and postoperative complications were investigated. Therapeutic success was defined as pain relief by at least 50 % without ongoing medication.
  
  
  RESULTS
  The visual analog scale (VAS) score was significantly reduced between the preoperative and most recent follow-up period. One year later, excellent or good results were achieved in 57 patients (83.9 %), but poor in 11 patients (16.1 %). The long-term outcome after 5 years was only slightly less than the 1-year outcome; 47 of the 68 patients (69.1 %) obtained therapeutic success. Longer duration of headache (over 13 years; p = 0.029) and presence of retro-orbital/frontal radiation (p = 0.040) were significantly associated with poor prognosis.
  
  
  CONCLUSIONS
  In the current study, C2 ganglion decompression provided durable, adequate pain relief with minimal complications in patients suffering from intractable occipital neuralgia. Due to the minimally invasive and nondestructive nature of this surgical procedure, C2 ganglion decompression is recommended as an initial surgical treatment option for intractable occipital neuralgia before attempting occipital nerve stimulation. However, further study is required to manage the pain recurrence associated with longstanding nerve injury.
authors.affiliation: Department of Neurosurgery, Hanyang University Medical Center, 17 Haengdang-dong, Seongdong-gu, 133-792, Seoul, Korea.
authors.forename: Kyu-Sun
authors.initials: KS
authors.lastname: Choi
authors.forename: Yong
authors.initials: Y
authors.lastname: Ko
authors.forename: Young-Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Hyeong-Joong
authors.initials: HJ
authors.lastname: Yi
mesh_terms: D000328:Adult; D000368:Aged; D066193:Cervical Cord / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000601:surgery*; D011184:Postoperative Period; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome