Iatrogenic Occipital Neuralgia After Scalp Epidermoid Cyst Excision: A Rare Case Report

Occipital neuralgia is a relatively frequent but often intractable headache disorder typically arising from trauma or nerve entrapment. While commonly associated with spontaneous or degenerative causes, iatrogenic occipital neuralgia following scalp surgery is rare and underreported in the literature. Reporting this case highlights the diagnostic challenge and surgical relevance of an underrecognized etiology.

A healthy 31-year-old female developed stabbing occipital pain radiating to the forehead after incomplete excision of a left occipital scalp tumor under local anesthesia. Examination revealed paroxysmal pain without sensory loss in the distribution of the greater occipital nerve, associated with dysesthesia and tenderness. A soft residual mass remained near the surgical site. Diagnostic occipital nerve block with lidocaine resulted in temporary pain relief, confirming occipital neuralgia. Surgical excision and neurolysis of the greater occipital nerve were performed. The patient experienced complete resolution of pain, with minimal residual numbness postoperatively.

This case illustrates a rare instance of iatrogenic occipital neuralgia following scalp surgery. It underscores the importance of evaluating prior surgical history in patients with new-onset occipital pain and highlights the utility of occipital nerve block as a diagnostic tool. Greater occipital nerve injury or local inflammatory sequelae may result in persistent neuropathic pain, which can be effectively addressed through decompression or neurolysis. Preoperative knowledge of neuroanatomy and meticulous surgical technique are vital to preventing such complications.