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J Neuroradiol. 2018 Oct;45(6):386-390. doi: 10.1016/j.neurad.2017.11.002. Epub 2017 Dec 19.

Greater occipital nerve cryoneurolysis in the management of intractable occipital neuralgia.

Author information

1
Neuroradiology and MRI Unit, University Hospital of Grenoble-Alpes, 38000 Grenoble, France. Electronic address: kastler.radio@gmail.com.
2
Neuroradiology and MRI Unit, University Hospital of Grenoble-Alpes, 38000 Grenoble, France.
3
Pain Management Unit, University Hospital of Grenoble-Alpes, 38000 Grenoble, France.
4
Neurosurgery Department, University Hospital of Grenoble-Alpes, 38000 Grenoble, France.
5
Adult Radiology Department, Necker University Hospital, Paris-Descartes University, 75000 Paris, France.

Abstract

OBJECTIVE:

To assess technical feasibility of cryoneurolysis of the greater occipital nerve in the management of occipital neuralgia.

METHODS:

Six patients suffering from unilateral refractory greater occipital neuralgia and who underwent 7 GON cryoneurolysis were assessed between October 2015 and January 2017. All procedures were performed under CT guidance and local anesthesia. A planning CT was performed with contrast enhancement to plan needle target and identify surrounding major vascular structures. A 12G coaxial needle (Inomed) was then inserted and targeted the first bend of the GON under and lateral to the obliquus capitis inferior muscle. A 2.0mm cryoprobe was then inserted in the coaxial and sensitive stimulation at 100Hz was performed. One to three freezing cycles were performed in one session.

RESULTS:

Technical feasibility was 100% as cryoneurolysis could be performed in all 7 cases with accurate sensitive nerve stimulation prior to freezing cycle. One patient benefited from a second session after failure of the first session. More than 50% pain reduction was achieved at day 7 in all cases, and 5 of 6 cases at one and three months follow-up.

CONCLUSION:

Cryoneurolysis of the GON in the management of refractory GON neuralgia is feasible. Initial results are promising as 5/7 cases benefited from a 3-month pain alleviation period.

KEYWORDS:

Cryoneurolysis; Greater occipital nerve; Neurolysis; Occipital neuralgia; Radiofrequency

PMID:
29273528
DOI:
10.1016/j.neurad.2017.11.002
[Indexed for MEDLINE]

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