Greater occipital neurectomy for refractory occipital neuralgia secondary to neurovascular compression: Anatomical Correlation, histopathological findings, and systematic review.
7 affiliations
- 1Department of Neurocirugia y Cirugia de Columna Vertebral y Minima Invasion, Hospital German Diaz Lombardo/Facultad Mexicana De Medicina La Salle, Mexico City, Mexico.
- 2Department of Neurocirugia y Cirugia de Columna Vertebral y Minima Invasion, Hospital German Diaz Lombardo, Mexico City, Mexico.
- 3Department of Servicio de Patología, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Centro Medico Nacional Siglo XXI, Mexico City, Mexico.
- 4Department of Jefe de Residentes Neurocirugía Hospital Regional Issste Primero de Octubre/Universidad Nacional Autónoma de México, Hospital 1 de Octubre, Ciudad de México, Mexico City, Mexico.
- 5Department of Faculty of Medicine, Westhill University, Mexico City, Mexico.
- 6Department of Neurosurgery, San Fernando Hospital, San Fernando, Argentina.
- 7Department of Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico.
Abstract
Background
Occipital neuralgia (ON), or Arnold's neuralgia, is a debilitating neuropathic pain disorder often attributed to muscular entrapment. However, increasing evidence suggests that neurovascular compression (NVC) by the occipital artery (OA) serves as a primary etiology in refractory cases. This study aims to evaluate the anatomical relationship between the greater occipital nerve (GON) and the OA through cadaveric morphometry, analyze clinical- histopathological correlation in surgical patients, and synthesize global evidence through a systematic review.Methods
We performed 18 cadaveric dissections using ImageJ morphometry to analyze the GON-OA complex at the superior nuchal line (1.39 mm mean distance). A clinical series of 25 pharmacoresistant patients was evaluated; three refractory cases underwent GON neurectomy with subsequent hematoxylin and eosin staining. Concurrently, a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines was conducted, integrating 21 core studies for qualitative synthesis.Results
Neurovascular contact was identified in 66% of cadaveric specimens, with a 27% prevalence of complex helical entanglement. Histopathological analysis of resected nerves revealed axonal distortion, perineural thickening, and focal myelin sheath dilation, confirming structural damage due to chronic pulsatility. The systematic review confirmed that surgical interventions addressing the vascular component significantly improve long-term clinical outcomes.Conclusion
Pulsatile NVC induces irreversible structural neuropathy, as evidenced by the axonal distortion found in our series. While decompression is viable in early stages, neurectomy of the third portion of the GON represents a definitive and justified therapeutic strategy for refractory Arnold's neuralgia with established nerve damage.
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BibTeX
@article{cordova2026greater,
title = {{Greater occipital neurectomy for refractory occipital neuralgia secondary to neurovascular compression: Anatomical Correlation, histopathological findings, and systematic review.}},
author = {Jonathan Samuel Zuñiga Cordova and Thania de Oca Mora and Marco Antonio Rodríguez Florido and Carlos Peñafiel Salgado and David Benavides and Daniel Sánchez Knupflemacher and Matias Baldoncini and Juan Carlos Lujan Guerra},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_452_2026},
url = {https://europepmc.org/article/MED/42974299},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Greater occipital neurectomy for refractory occipital neuralgia secondary to neurovascular compression: Anatomical Correlation, histopathological findings, and systematic review.
AU - Jonathan Samuel Zuñiga Cordova
AU - Thania de Oca Mora
AU - Marco Antonio Rodríguez Florido
AU - Carlos Peñafiel Salgado
AU - David Benavides
AU - Daniel Sánchez Knupflemacher
AU - Matias Baldoncini
AU - Juan Carlos Lujan Guerra
PY - 2026
DA - 2026/10/16
JO - Surgical neurology international
DO - 10.25259/sni_452_2026
UR - https://europepmc.org/article/MED/42974299
AB - Background Occipital neuralgia (ON), or Arnold's neuralgia, is a debilitating neuropathic pain disorder often attributed to muscular entrapment. However, increasing evidence suggests that neurovascular compression (NVC) by the occipital artery (OA) serves as a primary etiology in refractory cases. This study aims to evaluate the anatomical relationship between the greater occipital nerve (GON) and the OA through cadaveric morphometry, analyze clinical- histopathological correlation in surgical patients, and synthesize global evidence through a systematic review.Methods We performed 18 cadaveric dissections using ImageJ morphometry to analyze the GON-OA complex at the superior nuchal line (1.39 mm mean distance). A clinical series of 25 pharmacoresistant patients was evaluated; three refractory cases underwent GON neurectomy with subsequent hematoxylin and eosin staining. Concurrently, a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines was conducted, integrating 21 core studies for qualitative synthesis.Results Neurovascular contact was identified in 66% of cadaveric specimens, with a 27% prevalence of complex helical entanglement. Histopathological analysis of resected nerves revealed axonal distortion, perineural thickening, and focal myelin sheath dilation, confirming structural damage due to chronic pulsatility. The systematic review confirmed that surgical interventions addressing the vascular component significantly improve long-term clinical outcomes.Conclusion Pulsatile NVC induces irreversible structural neuropathy, as evidenced by the axonal distortion found in our series. While decompression is viable in early stages, neurectomy of the third portion of the GON represents a definitive and justified therapeutic strategy for refractory Arnold's neuralgia with established nerve damage.
SN - 2229-5097
SN - 2152-7806
ER -