Greater occipital nerve block for surgical resection of major infiltrating lesions of the posterior scalp

For the majority of scalp lesions, local anesthesia is adequate. In patients with more advanced lesions and who thus require sacrifice of a larger area of skin, general anesthesia is required but might be risky because of comorbid illness and/or advanced age, and surgery is sometimes abandoned. In cases with posterior scalp location, we suggest greater occipital nerve block–assisted resection. Since its first description by Bogduk,1 greater occipital nerve block has been used in neurosurgery as a part of anesthesia for supratentorial craniotomies, for chronic cluster headache,2 and to reduce postoperative occipital headache and posterior neck pain after thyroid surgery.3 To the best of our knowledge, greater occipital nerve block has not been systematically suggested for major oncologic scalp surgery.