Occipital Neuralgia from C2 Cavernous Malformation.

Area of Science:

• Neurology
• Neurosurgery
• Pain Medicine

Background:

• Occipital neuralgia (ON) is a chronic pain condition affecting the occipital nerves.
• Cavernous malformations (CMs) are vascular malformations that can occur in the brain and spinal cord.
• Intramedullary CMs in the cervical spinal cord are rare and can cause significant neurological symptoms.

Observation:

• A 53-year-old male presented with a 30-year history of chronic, severe occipital neuralgia.
• Magnetic resonance imaging revealed an intramedullary cavernous malformation at the C2 level of the spinal cord.
• Pain was exacerbated by neck extension and head movement, characteristic of ON.

Findings:

• The patient underwent C1-3 dorsal root rhizotomy with dentate ligament resection to decompress the affected nerves.
• Postoperatively, the patient experienced significant alleviation of paroxysmal lancinating pain associated with ON.
• Allodynic pain showed remodeling and improvement, with sustained relief observed for 24 months.

Implications:

• Dorsal root rhizotomy can be an effective treatment for chronic occipital neuralgia secondary to intramedullary spinal cord lesions.
• This intervention may help reduce central sensitization in the trigeminocervical complex by decreasing afferent input.
• Surgical management should be considered for carefully selected cases of ON caused by cervicomedullary CMs.