Treatment of occipital neuralgia by partial posterior rhizotomy at C1-3.

To minimize the sensory loss associated with intradural posterior rhizotomy for medically refractory occipital neuralgia, partial sectioning of the upper cervical posterior rootlets was performed in 11 patients. The ventrolateral aspect of each posterior rootlet from C-1 to the upper portion of C-3 was divided at the root entry zone. In three patients with bilateral neuralgia, the procedure was performed on both sides, for a total of 14 partial rhizotomy procedures in the 11 patients. This resulted in satisfactory preservation of scalp sensation in all cases. Pain within the territory of the greater occipital nerve was consistently reduced or abolished by this procedure. The overall degree of pain relief was rated good or excellent after 10 of the 14 procedures. The other four procedures alleviated pain in the territory of the greater occipital nerve, but the results were marred by persistent periorbital or temporal pain. Two patients subsequently underwent complete C1-3 posterior rhizotomy without further improvement. Although partial posterior rhizotomy at C1-3 did not always relieve pain in the periorbital and temporal regions, this procedure did provide consistent long-term relief of severe occipital pain with minimal risk of postoperative vertigo, scalp anesthesia, or deafferentation syndrome.