Greater Houston Pain Consultants, 2411 Fountain View Dr. Houston, TX, USA; Houston Texas Pain Management, Houston Texas.
Neuromodulation. 2010 Apr;13(2):126-30. doi: 10.1111/j.1525-1403.2009.00254.x. Epub 2009 Oct 29.
Occipital nerve stimulation (ONS) is a peripheral nerve stimulation (PNS) technique that has been used with success in the management of intractable chronic daily headaches (CDHs) and occipital neuralgia (ON). The technique involves the placement of a stimulating surgical or percutaneous electrode over the occipital nerves within the subcutaneous tissues at the skull base. Until recently, procedures involving the occipital nerves were based on identifying bony or arterial landmarks with direct palpation or fluoroscopy. Although universally accepted as an imaging technique, fluoroscopy does not provide real-time imaging of the occipital nerves or vessels. Furthermore, therapeutic efficacy of ONS is directly related to the ability of the stimulating electrode to produce peripheral nerve dermatomal paresthesia, emphasizing the need for precision placement.
A total of six patients, diagnosed with refractory CDH and ON, after failing extensive medical management, were diagnosed as potential candidates for ONS. Subsequently, all underwent successful percutaneous trials of bilateral octopolar (Advanced Neuromodulation Systems, Plano, TX, USA) ONS under ultrasound guidance, followed by permanent surgical implantation.
In this case series, ultrasound provided accurate, real-time placement of introducer needles and stimulating electrodes by allowing visualization of tissue planes (epidermis, dermis, subcutaneous fat, and trapezious muscle), as well as vessels and nervous structures.
Ultrasound imaging has been used increasingly for peripheral nerve blockade in surgical anesthesia and in chronic pain management as it allows real-time localization of both nervous and vascular structures (color flow Doppler) and, thus, a method for increasing blockade precision and safety. As an adjunct to ONS, the position of the introducer needles and electrodes can be visualized in relation to the occipital nerves and vasculature. This reproducible positioning allows accurate depth of placement (assuring production of the prerequisite PNS dermatomal paresthesia required for ONS efficacy) and limits the risk of injury to the occipital artery or nerve(s). In this case series, ultrasonography provided real-time, safe, and reliable placement of ONS electrodes. It also allowed identification of nervous and vascular structures unable to be seen with fluoroscopy, The portable nature of modern ultrasound machines, together with an ever improving pixelation of the Doppler color flow images/real-time measurements, and a lack of radiation exposure make this technology an attractive emerging modality in the field of Neuromodulation.
枕神经刺激（ONS）是一种外周神经刺激（PNS）技术，已成功应用于治疗难治性慢性每日头痛（CDH）和枕神经痛（ON）。该技术涉及在颅底皮下组织中枕神经上方放置刺激手术或经皮电极。直到最近，涉及枕神经的手术都是基于直接触诊或透视识别骨性或动脉性标志。虽然透视被普遍认为是一种影像学技术，但它不能实时显示枕神经或血管。此外，ONS 的治疗效果与刺激电极产生外周神经皮节感觉异常的能力直接相关，这强调了精确放置的必要性。
共有 6 名患者被诊断为难治性 CDH 和 ON，他们在广泛的药物治疗失败后，被诊断为 ONS 的潜在候选者。随后，所有患者均在超声引导下成功进行了双侧八极（美国得克萨斯州普莱诺先进神经调节系统公司）ONS 的经皮试验，随后进行了永久性手术植入。
在本病例系列中，超声通过显示组织平面（表皮、真皮、皮下脂肪和斜方肌）、血管和神经结构，实现了导针和刺激电极的准确、实时放置。
超声成像已越来越多地用于手术麻醉中的外周神经阻滞和慢性疼痛管理，因为它可以实时定位神经和血管结构（彩色血流多普勒），从而提高阻滞的精度和安全性。作为 ONS 的辅助手段，可以在与枕神经和血管相关的位置显示导针和电极的位置。这种可重复的定位允许准确的放置深度（确保产生 ONS 疗效所需的 PNS 皮节感觉异常），并降低损伤枕动脉或神经（s）的风险。在本病例系列中，超声实时、安全、可靠地放置了 ONS 电极。它还可以识别透视无法看到的神经和血管结构。现代超声机的便携性、不断提高的多普勒彩色血流图像/实时测量的像素化程度以及无辐射暴露，使这项技术成为神经调节领域中一种有吸引力的新兴模式。
