PMC5346380_01
A schematic diagram demonstrating the distribution of occipital neuralgia and hemifacial sensory change with facial pain. (a) The grey areas over the left occipital area indicate the distribution of stabbing pain of occipital neuralgia. A tender point was present along the course of the greater occipital nerve. (b) The obliquely hatched area denotes regions of facial pain in addition to hypesthesia. The horizontally hatched area shows the distribution of hemifacial hypesthesia and paresthesia.
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fig1
It was present over the distribution of the left GON (Figure 1(a)). A moderate degree of hypesthesia to light touch, increased sensitivity to pinprick, and paresthesia were observed in her right face (V1, V2, and V3) (Figure 1(b)).
Intraoperative photographs during the decompression of the greater occipital nerve. (a) An intraoperative photograph showing adhesions of the greater occipital nerve (white arrows) with the connective tissue (black arrow heads) and occipital arteries (black arrows). (b) An intraoperative photograph after decompression of the left greater occipital nerve. A reddish deformation is apparent in the compressed portion (white arrows) with pathological vascular contact compared to the normal proximal course (black arrow) of the greater occipital nerve.
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fig2
Upon dissection along the distal course of the GON, a severe adhesion to the surrounding connective tissue and entrapment of the GON between tributaries of the occipital artery were encountered (Figure 2(a)). The connective tissue adhesion around the GON was released to decompress the GON (Figure 2(b)).