Greater occipital nerve iatrogenic neuroma after cervical arthrodesis: high-frequency ultrasound findings and ultrasound-guided management.
Cláudia Fontan, Carolina Ávila de Almeida, Danielle Martiniano da Silva Rodrigues et al.
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Case in brief
A 45-year-old woman developed refractory bilateral occipital pain consistent with occipital neuralgia after cervical arthrodesis for disc herniation. High-resolution ultrasound at 24 MHz showed postoperative changes and focal fusiform thickening with loss of fascicular architecture in the right greater occipital nerve where it perforated muscle, findings consistent with an iatrogenic neuroma. The ultrasound findings guided targeted management, including percutaneous treatment. The case illustrates how nerve-focused ultrasound can identify a structural cause of persistent postsurgical occipital pain.
What made this case unusual
The neuroma was localized by ultrasound to the greater occipital nerve’s muscular perforation site, with focal thickening and loss of fascicular architecture.
Diagnostic / clinical pearl
In persistent occipital neuralgia after cervical arthrodesis, high-resolution ultrasound can assess occipital nerve morphology and continuity and help identify a focal neuroma.