scholarly journals Ultrasound-Guided Intermediate Site Greater Occipital Nerve Infiltration: A Technical Feasibility Study

2016 ◽  
Vol 7;19 (7;9) ◽  
pp. E1027-E1034 ◽  
Author(s):  
Jonathan Zipfel
Keyword(s):  
Retrospective Study ◽  
Occipital Neuralgia ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Technical Feasibility ◽  
Occipital Nerve ◽  
Pain Syndromes ◽  
Greater Occipital Nerve ◽  
Craniofacial Pain ◽  
Block Test

Background: Two studies recently reported that computed tomography (CT) guided infiltration of the greater occipital nerve at its intermediate site allows a high efficacy rate with long-lasting pain relief following procedure in occipital neuralgia and in various craniofacial pain syndromes. Objective: The purpose of our study was to evaluate the technical feasibility and safety of ultrasound-guided intermediate site greater occipital nerve infiltration. Study Design: Retrospective study. Setting: This study was conducted at the imaging department of a 1,409 bed university hospital. Methods: Local institutional review board approval was obtained and written consent was waived. In this retrospective study, 12 patients suffering from refractory occipital neuralgia or craniofacial pain syndromes were included between April and October 2014. They underwent a total of 21 ultrasound-guided infiltrations. Infiltration of the greater occipital nerve was performed at the intermediate site of the greater occipital nerve, at its first bend between obliqus capitis inferior and semispinalis capitis muscles with local anestetics and cortivazol. Technical success was defined as satisfactory diffusion of added iodinated contrast media in the fatty space between these muscles depicted on control CT scan. We also reported first data of immediate block test efficacy and initial clinical efficacy at 7 days, one month, and 3 months, defined by a decrease of at least 50% of visual analog scale (VAS) scores. Results: Technical success rate was 95.24%. Patients suffered from right unilateral occipital neuralgia in 3 cases, left unilateral occipital neuralgia in 2 cases, bilateral occipital neuralgia in 2 cases, migraine in one case, cervicogenic headache in one case, tension-type headache in 2 cases, and cluster headache in one case. Block test efficacy was found in 93.3% (14/15) cases. Clinical efficacy was found in 80% of cases at 7 days, in 66.7% of cases at one month and in 60% of cases at 3 months. No major complications were noted. Limitations: Some of the limitations of our study include that it represents a single institution. The low number of infiltrations included in this study, for this guidance procedure, is another bias. Conclusions: This ultrasound-guided infiltration technique appears to be feasible, safe, nonionizing, and fast when targeting the greater occipital nerve in its intermediate portion. This imaging guidance modality should be used in routine clinical practice. Key words: Greater occipital nerve, infiltration, ultrasound guidance, corticosteroids, occipital neuralgia, craniofacial pain syndrome

scholarly journals CT-guided infiltration of greater occipital nerve for refractory craniofacial pain syndromes other than occipital neuralgia

2020 ◽  
Vol 101 (10) ◽  
pp. 643-648
Author(s):  
A. Ricquart Wandaele ◽  
A. Kastler ◽  
A. Comte ◽  
G. Hadjidekov ◽  
R. Kechidi ◽  
...  
Keyword(s):  
Occipital Neuralgia ◽  
Ct Guided ◽  
Occipital Nerve ◽  
Pain Syndromes ◽  
Greater Occipital Nerve ◽  
Craniofacial Pain

Greater Occipital Nerve Decompression for Occipital Neuralgia

2018 ◽  
Vol 29 (5) ◽  
pp. e518-e521 ◽  
Author(s):  
Anson Jose ◽  
Shakil Ahmed Nagori ◽  
Probodh K. Chattopadhyay ◽  
Ajoy Roychoudhury
Keyword(s):  
Occipital Neuralgia ◽  
Occipital Nerve ◽  
Nerve Decompression ◽  
Greater Occipital Nerve

Treatment of occipital neuralgia by partial posterior rhizotomy at C1–3

1995 ◽  
Vol 82 (4) ◽  
pp. 581-586 ◽  
Author(s):  
David Dubuisson
Keyword(s):  
Sensory Loss ◽  
Minimal Risk ◽  
Occipital Neuralgia ◽  
Content Type ◽  
Occipital Nerve ◽  
Root Entry Zone ◽  
Relieve Pain ◽  
Greater Occipital Nerve ◽  
Upper Cervical ◽  
Postoperative Vertigo

✓ To minimize the sensory loss associated with intradural posterior rhizotomy for medically refractory occipital neuralgia, partial sectioning of the upper cervical posterior rootlets was performed in 11 patients. The ventrolateral aspect of each posterior rootlet from C-1 to the upper portion of C-3 was divided at the root entry zone. In three patients with bilateral neuralgia, the procedure was performed on both sides, for a total of 14 partial rhizotomy procedures in the 11 patients. This resulted in satisfactory preservation of scalp sensation in all cases. Pain within the territory of the greater occipital nerve was consistently reduced or abolished by this procedure. The overall degree of pain relief was rated good or excellent after 10 of the 14 procedures. The other four procedures alleviated pain in the territory of the greater occipital nerve, but the results were marred by persistent periorbital or temporal pain. Two patients subsequently underwent complete C1–3 posterior rhizotomy without further improvement. Although partial posterior rhizotomy at C1–3 did not always relieve pain in the periorbital and temporal regions, this procedure did provide consistent long-term relief of severe occipital pain with minimal risk of postoperative vertigo, scalp anesthesia, or deafferentation syndrome.

scholarly journals Neurostimulation for the Treatment of Chronic Head and Facial Pain: A Literature Review

2019 ◽  
Vol 5 (22;5) ◽  
pp. 447-477
Author(s):  
Ajay Antony
Keyword(s):  
Peripheral Nerve ◽  
Cluster Headache ◽  
Nerve Stimulation ◽  
Facial Pain ◽  
Current Evidence ◽  
Occipital Neuralgia ◽  
Occipital Nerve Stimulation ◽  
Peripheral Nerve Stimulator ◽  
Occipital Nerve ◽  
Craniofacial Pain

Background: Head and facial pain is a common and often difficult to treat disorder. Routine treatments sometimes fail to provide acceptable relief, leaving the patient searching for something else, including narcotics and surgery. Recently, neuromodulation has been expanding to provide another option. Secondary to its potentially temporary nature and relatively manageable risk profile, several reviews have suggested trialing neuromodulation prior to starting narcotics or invasive permanent surgeries. There is evidence that neuromodulation can make a difference in those patients with intractable severe craniofacial pain. Objectives: To provide a basic overview of the anatomy, epidemiology, pathophysiology and common treatments of several common head and facial disorders. Furthermore, to demonstrate the suggested mechanisms of neuromodulation and the evidence currently existing for the use of neuromodulation. Methods: A comprehensive review was performed regarding the available literature through targeting articles reporting on the use of neuromodulation to treat pain of the head and face. Results: We compiled and discuss the current evidence available in treating head and facial pain. The strongest evidence currently for neuromodulation is for occipital nerve stimulation for migraine, transcutaneous vagal nerve stimulation for migraine and cluster headache, sphenopalatine ganglion microstimulation for cluster headache, and transcutaneous supraorbital and supratrochlear nerve stimulation for migraine. In addition, there is moderate evidence for occipital nerve stimulation in treating occipital neuralgia. Limitations: Neuromodulation has been trialed and is promising in several craniofacial pain disorders; however, there remains a need for large-scale, randomized, placebo-controlled clinical trials to further evaluate the efficacy and safety of most treatments. Much of the current data relies on case reports without randomization or placebo controls. Conclusions: With advancing techniques and technology, neuromodulation can be promising in treating intractable pain of the head and face. Although more randomized controlled trials are warranted, the current literature supports the use of neuromodulation in intractable craniofacial pain. Key words: Neuromodulation, headache, facial pain, craniofacial pain, migraine, cluster headache, trigeminal neuralgia, occipital neuralgia, peripheral nerve stimulator, high cervical spinal cord stimulator, peripheral nerve field stimulator

Greater Occipital Nerve Excision for Occipital Neuralgia Refractory to Nerve Decompression

2014 ◽  
Vol 72 (2) ◽  
pp. 184-187 ◽  
Author(s):  
Ivica Ducic ◽  
John M. Felder ◽  
Neelam Khan ◽  
Sojin Youn
Keyword(s):  
Occipital Neuralgia ◽  
Occipital Nerve ◽  
Nerve Decompression ◽  
Greater Occipital Nerve

A simplified CT-guided approach for greater occipital nerve infiltration in the management of occipital neuralgia

2015 ◽  
Vol 25 (8) ◽  
pp. 2512-2518 ◽  
Author(s):  
Adrian Kastler ◽  
Yannick Onana ◽  
Alexandre Comte ◽  
Arnaud Attyé ◽  
Jean-Louis Lajoie ◽  
...  
Keyword(s):  
Occipital Neuralgia ◽  
Ct Guided ◽  
Occipital Nerve ◽  
Greater Occipital Nerve
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