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C2 cavernous malformtion

1 Department of Neurosurgery, Chosun University Hospital, College of Medicine, Chosun University, Gwangju, Republic of Korea
2 Department of Neurosurgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea
3 Department of Neurosurgery, Seoul St. Mary's Hospital, Seoul; Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

Correspondence Address:
Byung-chul Son,
Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic Neuroscience Institute College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 06591 Seoul
Republic of Korea
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Source of Support: None, Conflict of Interest: None

A unique case is presented of chronic occipital neuralgia (ON) caused by cavernous malformation (CM) in the intramedullary C2 spinal cord and subsequent pain relief and remodeling of allodynic pain following dorsal root rhizotomy. A 53-year-old male presented with a 30-year history of chronic allodynic, paroxysmal lancinating pain in the greater and lesser occipital nerves. Typically, the pain was aggravated with neck extension and head movement. Magnetic resonance imaging showed a CM in the right posterolateral side of the intramedullary C2 cord. Considering potential risks associated with removal of the lesion, intradural C1-3 dorsal root rhizotomy with dentate ligament resection was performed. The paroxysmal lancinating pain of ON was significantly alleviated, and the remodeling of the extent of allodynic pain was noted after C1-3 dorsal root rhizotomy. These changes gradually occurred during the second postoperative month, and this effect was maintained for 24 months postoperatively. Significant reduction in chronic allodynic pain of secondary ON caused by cervicomedullary CM involving central sensitization in the trigeminocervical complex was observed with reduction of irritating, afferent input with C1-C3 dorsal root rhizotomy.

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