Our surgical experience in Arnold's neuralgia: Technical insights and clinical results

Arnold's neuralgia, also referred to as greater occipital neuralgia, is a chronic neuropathic pain condition characterized by paroxysmal or continuous occipital pain. While most patients respond to conservative treatment, a subset develops medically refractory symptoms requiring surgical intervention.

To present our institutional experience with isolated surgical decompression of the greater occipital nerve, focusing on technical aspects, clinical outcomes, and patient satisfaction.

A retrospective review was conducted of 29 consecutive patients who underwent surgical decompression of the greater occipital nerve between September 2015 and December 2024. All patients fulfilled the ICHD-3 diagnostic criteria and had failed multimodal conservative treatment. Pain intensity was evaluated using the visual analog scale (VAS) preoperatively and at 1, 3, and 6 months postoperatively.

Mean VAS decreased from 6.59 preoperatively to 3.24 at 6 months, representing a 50.8% reduction in pain intensity (p < 0.001). Eighteen patients (62%) achieved a ≥ 50% reduction in pain, while 90% experienced some degree of postoperative improvement. Postoperative complications were infrequent and predominantly mild, with no infections or major neurological deficits observed.

Isolated decompression of the greater occipital nerve is a safe and effective surgical option for carefully selected patients with refractory Arnold's neuralgia.