Abstract：
BACKGROUND: This study analyzed the etiologies and treatment of iatrogenic occipital nerve injuries.
METHODS: Patients with occipital neuralgia (ON) who were screened for occipital nerve decompression surgery were prospectively enrolled. Patients with iatrogenic occipital nerve injuries who underwent nerve decompression surgery were identified. Data included surgical history, pain characteristics, and surgical technique. Outcomes included pain frequency (days/month), duration (h/day), intensity (0-10), migraine headache index (MHI), and patient-reported percent-resolution of pain.
RESULTS: Among the 416 patients with ON, who were screened for occipital nerve decompression surgery, 12 (2.9%) cases of iatrogenic occipital nerve injury were identified and underwent surgical treatment. Preoperative headache frequency was 30 (±0.0) days/month, duration was 19.4 (±6.9) h, and intensity was 9.2 (±0.9). Neuroma excision was performed in 5 cases followed by targeted muscle reinnervation in 3, nerve cap in 1, and muscle burial in 1. In patients without neuromas, greater occipital nerve decompression and/or lesser occipital nerve neurectomy were performed. At the median follow-up of 12 months (IQR 12-12 months), mean pain frequency was 4.0 (±6.6) pain days/month (p < 0.0001), duration was 6.3 (±8.9) h (p < 0.01), and intensity was 4.4 (±2.8) (p < 0.001). Median patient-reported resolution of pain was 85% (56.3%-97.5%) and success rate was (≥50% MHI improvement) 91.7%.
CONCLUSIONS: Iatrogenic occipital nerve injuries can be caused by various surgical interventions, including craniotomies, cervical spine interventions, and scalp tumor resections. The associated pain can be severe and chronic. Iatrogenic ON should be considered in the differential diagnosis of post-operative headaches and can be treated with nerve decompression surgery or neuroma excision with reconstruction of the free nerve end.
METHODS: Patients with occipital neuralgia (ON) who were screened for occipital nerve decompression surgery were prospectively enrolled. Patients with iatrogenic occipital nerve injuries who underwent nerve decompression surgery were identified. Data included surgical history, pain characteristics, and surgical technique. Outcomes included pain frequency (days/month), duration (h/day), intensity (0-10), migraine headache index (MHI), and patient-reported percent-resolution of pain.
RESULTS: Among the 416 patients with ON, who were screened for occipital nerve decompression surgery, 12 (2.9%) cases of iatrogenic occipital nerve injury were identified and underwent surgical treatment. Preoperative headache frequency was 30 (±0.0) days/month, duration was 19.4 (±6.9) h, and intensity was 9.2 (±0.9). Neuroma excision was performed in 5 cases followed by targeted muscle reinnervation in 3, nerve cap in 1, and muscle burial in 1. In patients without neuromas, greater occipital nerve decompression and/or lesser occipital nerve neurectomy were performed. At the median follow-up of 12 months (IQR 12-12 months), mean pain frequency was 4.0 (±6.6) pain days/month (p < 0.0001), duration was 6.3 (±8.9) h (p < 0.01), and intensity was 4.4 (±2.8) (p < 0.001). Median patient-reported resolution of pain was 85% (56.3%-97.5%) and success rate was (≥50% MHI improvement) 91.7%.
CONCLUSIONS: Iatrogenic occipital nerve injuries can be caused by various surgical interventions, including craniotomies, cervical spine interventions, and scalp tumor resections. The associated pain can be severe and chronic. Iatrogenic ON should be considered in the differential diagnosis of post-operative headaches and can be treated with nerve decompression surgery or neuroma excision with reconstruction of the free nerve end.
摘要：
背景：本研究分析了医源性枕骨神经损伤的病因和治疗方法。
方法：前瞻性地纳入了接受枕神经减压术筛查的枕神经痛（ON）患者。确定了接受神经减压手术的医源性枕神经损伤患者。数据包括手术史，疼痛的特点，和手术技术。结果包括疼痛频率（天/月），持续时间（h/天），强度（0-10），偏头痛指数（MHI），和患者报告的疼痛百分比分辨率。
结果：在416例ON患者中，接受枕骨神经减压手术筛查的人，发现12例（2.9％）医源性枕神经损伤并接受手术治疗。术前头痛频率为30(±0.0)天/月,持续时间为19.4(±6.9)h，强度为9.2（±0.9）。5例进行神经瘤切除术，3例进行针对性肌肉神经支配，1例进行神经帽，1例进行肌肉埋藏。在没有神经瘤的患者中，进行枕大神经减压术和/或枕小神经切除术.在12个月的中位随访时间（IQR12-12个月），平均疼痛频率为4.0（±6.6）个疼痛日/月（p<0.0001），持续时间为6.3（±8.9）h（p<0.01），强度为4.4（±2.8）（p<0.001）。患者报告的疼痛缓解率为85％（56.3％-97.5％），成功率为91.7％（MHI改善≥50％）。
结论：医源性枕神经损伤可由各种手术干预引起，包括开颅手术,颈椎干预，头皮肿瘤切除.相关的疼痛可以是严重的和慢性的。在术后头痛的鉴别诊断中应考虑医源性ON，可以通过神经减压手术或神经瘤切除术并重建游离神经末端来治疗。
方法：前瞻性地纳入了接受枕神经减压术筛查的枕神经痛（ON）患者。确定了接受神经减压手术的医源性枕神经损伤患者。数据包括手术史，疼痛的特点，和手术技术。结果包括疼痛频率（天/月），持续时间（h/天），强度（0-10），偏头痛指数（MHI），和患者报告的疼痛百分比分辨率。
结果：在416例ON患者中，接受枕骨神经减压手术筛查的人，发现12例（2.9％）医源性枕神经损伤并接受手术治疗。术前头痛频率为30(±0.0)天/月,持续时间为19.4(±6.9)h，强度为9.2（±0.9）。5例进行神经瘤切除术，3例进行针对性肌肉神经支配，1例进行神经帽，1例进行肌肉埋藏。在没有神经瘤的患者中，进行枕大神经减压术和/或枕小神经切除术.在12个月的中位随访时间（IQR12-12个月），平均疼痛频率为4.0（±6.6）个疼痛日/月（p<0.0001），持续时间为6.3（±8.9）h（p<0.01），强度为4.4（±2.8）（p<0.001）。患者报告的疼痛缓解率为85％（56.3％-97.5％），成功率为91.7％（MHI改善≥50％）。
结论：医源性枕神经损伤可由各种手术干预引起，包括开颅手术,颈椎干预，头皮肿瘤切除.相关的疼痛可以是严重的和慢性的。在术后头痛的鉴别诊断中应考虑医源性ON，可以通过神经减压手术或神经瘤切除术并重建游离神经末端来治疗。
