Occipital neuralgia as the presenting symptom of osteoblastoma

Occipital neuralgia as the presenting symptom of osteoblastoma

Hassan Baallal^1,2,&, Ali Akhaddar¹

¹Department of Neurosurgery, Avicenne Military Teaching Hospital, University Caddi Ayyad , Marrakech, Morocco, ²Fourth Military Hospital Dakhla, Moroccan Sahara, Morocco

^&Corresponding author
Hassan Baallal, Department of Neurosurgery, Avicenne Military Teaching Hospital, University Caddi Ayyad , Marrakech, Morocco

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Osteoblastoma is an uncommon benign bone tumor which accounts for approximately 1% of all primary bone tumors. It is commonly seen in the long tubular bones and in the vertebral column. It is rarely found in the calvarium. The tumor has a preference for frontal and temporal bones and has rarely been reported in the occipital bone. In one large study of 306 osteoblastomas, only 11 (4%) were located in the calvarium. To date, only 62 cases of calvarial osteoblastoma, have been reported in the English literature. A 34-year-old man, he had occipital neuralgia with intense pain that feels like a sharp, jabbing, electric shock in the back of the head and neck,he presented a mild tender progressive swelling in the occipital area, which had persisted for 6 months prior to the patient´s admission. The patient appeared otherwise well, and had no significant past traumas or medical history. A physical examination revealed a hard smooth mass, which was fixed to the underlying occipital bone. The skin overlying the lesion was normal and did not adhere to the mass. There were no neurological deficits. Computed tomography (CT) scanning of the brain using bone reconstruction techniques showed a midline occipital suboccipital bony lesion and extending from the torcula (A,B). During surgery, the mass was completely excised by en bloc removal, after making a burr hole in the surrounding normal bone. Postoperative management is straightforward with immediate disappearance of occipital neuralgia. The findings of histopathological examination were consistent with the diagnosis of a benign osteoblastoma.

Figure 1: (A,B) computed tomography (CT) scanning of the brain axial in, with sagittal bone reconstruction showed a occipital osteoblastoma (arrows)