J Korean Neurosurg Soc.  2013 Sep;54(3):268-271. 10.3340/jkns.2013.54.3.268.

Intractable Occipital Neuralgia Caused by an Entrapment in the Semispinalis Capitis

• Son BC
• Kim DR
• Lee SW

• KMID: 2190913
• DOI: http://doi.org/10.3340/jkns.2013.54.3.268

Abstract

Occipital neuralgia is a rare pain syndrome characterized by periodic lancinating pain involving the occipital nerve complex. We present a unique case of entrapment of the greater occipital nerve (GON) within the semispinalis capitis, which was thought to be the cause of occipital neuralgia. A 66-year-old woman with refractory left occipital neuralgia revealed an abnormally low-loop of the left posterior inferior cerebellar artery on the magnetic resonance imaging, suggesting possible vascular compression of the upper cervical roots. During exploration, however, the GON was found to be entrapped at the perforation site of the semispinalis capitis. There was no other compression of the GON or of C1 and C2 dorsal roots in their intracranial course. Postoperatively, the patient experienced almost complete relief of typical neuralgic pain. Although occipital neuralgia has been reported to occur by stretching of the GON by inferior oblique muscle or C1-C2 arthrosis, peripheral compression in the transmuscular course of the GON in the semispinalis capitis as a cause of refractory occipital neuralgia has not been reported and this should be considered when assessing surgical options for refractory occipital neuralgia.

Keyword

Entrapment; Greater occipital nerve; Occipital neuralgia; Semispinalis capitis

MeSH Terms

Aged
Arteries
Female
Humans
Magnetic Resonance Imaging
Muscles
Neuralgia*
Spinal Nerve Roots

Figure

• 

  Fig. 1 A : Sagittal, fast-spin echo T2-weighted magnetic resonance images of the occipito-cervical junction showing the anomalous course of the left posterior inferior cerebellar artery (arrow). B : Coronal, reformatted computed tomography-myelogram images of the occipito-cervical junction showing the tortuous and caudal course of the posterior inferior cerebellar artery as it closes the C1 lamina (arrow).

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  Fig. 2 A : Intraoperative photographs showing the constriction of the greater occipital nerve in its perforation site of the semispinaliscapitis muscle. B : A photograph showing no constriction along the peripheral course of the greater occipital nerve proximal to the semispinalis to the C2, 3 facet. C : An intraoperative photograph showing no vascular contact between the C1, 2 nerve roots and the posterior inferior cerebellar artery.

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