New Technique for Cryoneuroablation of the Proximal Greater Occipital Nerve.
GON
cephalgia
cryoablation
cryoanalgesia
cryoneuroablation
headache
migraine
occipital neuralgia
proximal occipital neuralgia
Journal
Pain practice : the official journal of World Institute of Pain
ISSN: 1533-2500
Titre abrégé: Pain Pract
Pays: United States
ID NLM: 101130835
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
received:
19
10
2018
revised:
31
01
2019
accepted:
13
02
2019
pubmed:
2
3
2019
medline:
24
12
2019
entrez:
2
3
2019
Statut:
ppublish
Résumé
Description of a new technique. To describe a safe ultrasound (US)-guided cryoneuroablation technique of the proximal greater occipital nerve (GON). Cryoneuroablation is a treatment option for occipital neuralgia, providing more sustained relief when steroid injections fail. US can identify the proximal GON between the C2 spinous and C1 transverse process over the inferior oblique capitis muscle (IOCM), where the GON is clearly visualized. US-guided GON injections are often performed with an out-of-plane approach; however, that approach is difficult with cryoneuroablation, because the probe has no opening (prohibiting hydrodissection), and the size and dullness of the probe hinders easy manipulation. University-based outpatient pain clinic. We provide a description of the procedure based on experience in the authors' clinic. With the patient in the prone position, the US probe is placed parallel to the IOCM. The GON is seen on top of the IOCM; a midline 2-mm incision allows access to the bilateral GONs with a single skin entry. Using an in-plane approach, the cryo probe is advanced to the nerve in a medial-to-lateral direction, with constant US visualization, staying far away from the spinal cord and vertebral artery, which increases safety. Based on anecdotal evidence from the authors' clinic, cryoneuroablation of the proximal GON can be performed safely at the level of the IOCM. The procedure described is based on anecdotal evidence from a small number of patients; however, the procedure is promising and formal study is warranted.
Sections du résumé
STUDY DESIGN
Description of a new technique.
OBJECTIVES
To describe a safe ultrasound (US)-guided cryoneuroablation technique of the proximal greater occipital nerve (GON).
BACKGROUND
Cryoneuroablation is a treatment option for occipital neuralgia, providing more sustained relief when steroid injections fail. US can identify the proximal GON between the C2 spinous and C1 transverse process over the inferior oblique capitis muscle (IOCM), where the GON is clearly visualized. US-guided GON injections are often performed with an out-of-plane approach; however, that approach is difficult with cryoneuroablation, because the probe has no opening (prohibiting hydrodissection), and the size and dullness of the probe hinders easy manipulation.
SETTING
University-based outpatient pain clinic.
METHODS
We provide a description of the procedure based on experience in the authors' clinic. With the patient in the prone position, the US probe is placed parallel to the IOCM. The GON is seen on top of the IOCM; a midline 2-mm incision allows access to the bilateral GONs with a single skin entry. Using an in-plane approach, the cryo probe is advanced to the nerve in a medial-to-lateral direction, with constant US visualization, staying far away from the spinal cord and vertebral artery, which increases safety.
CONCLUSIONS
Based on anecdotal evidence from the authors' clinic, cryoneuroablation of the proximal GON can be performed safely at the level of the IOCM.
LIMITATIONS
The procedure described is based on anecdotal evidence from a small number of patients; however, the procedure is promising and formal study is warranted.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
594-601Informations de copyright
© 2019 World Institute of Pain.