Nerve Decompression in Occipital Neuralgia: A Systematic Review and Meta-analysis

Occipital neuralgia (ON) is a debilitating craniofacial pain disorder often refractory to conservative treatments. Nerve decompression surgery has emerged as a promising intervention, yet the long-term efficacy and optimal patient selection remain unclear. This systematic review and meta-analysis evaluate the effectiveness of occipital nerve decompression in reducing pain frequency, intensity, and duration in patients with ON. A systematic search of PubMed, Embase, and Scopus was conducted following PRISMA guidelines. Studies evaluating greater occipital nerve (GON) or lesser occipital nerve (LON) decompression for ON were included. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the Joanna Briggs Institute (JBI) checklist for case series and observational studies. A random-effects meta-analysis estimated pooled effects on pain reduction, and heterogeneity was analyzed using I ² statistics. Twelve studies comprising 838 patients were included. Meta-analysis demonstrated a significant reduction in pain frequency by 20.30 days/month (95% CI: 16.53–24.08, P <0.0001) following nerve decompression. Subgroup analysis revealed superior outcomes for post-traumatic ON, while chronic migraine-related ON showed more variability. Technique modifications, such as midline versus separate incisions for LON decompression, influenced reoperation rates (4.4% versus 15.2%, P <0.05). Heterogeneity was high ( I ²=97.21%), likely due to surgical variability and patient selection differences. Nerve decompression significantly reduces ON-related pain, though patient selection and surgical technique optimization remain crucial. Standardized protocols and prospective trials are needed to refine clinical guidelines.