Neuroradiology and MRI Unit, University Hospital of Grenoble-Alpes, 38000 Grenoble, France.
Neuroradiology and MRI Unit, University Hospital of Grenoble-Alpes, 38000 Grenoble, France.
J Neuroradiol. 2018 Oct;45(6):386-390. doi: 10.1016/j.neurad.2017.11.002. Epub 2017 Dec 19.
To assess technical feasibility of cryoneurolysis of the greater occipital nerve in the management of occipital neuralgia.
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.
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.
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.
评估冷冻神经松解术治疗枕大神经痛的技术可行性。
2015 年 10 月至 2017 年 1 月期间，对 6 例单侧难治性枕大神经痛患者进行了 7 次 GON 冷冻神经松解术。所有手术均在 CT 引导和局部麻醉下进行。进行了对比增强 CT 检查，以规划针靶并识别周围主要血管结构。然后插入 12G 同轴针（Inomed），并在斜方肌下和外侧靶向 GON 的第一弯曲处。然后将 2.0mm 的冷冻探针插入同轴内，并在 100Hz 时进行敏感刺激。在一次治疗中进行 1 到 3 个冷冻周期。
技术可行性为 100%，因为在冷冻周期之前，可以对所有 7 例进行准确的敏感神经刺激。1 例患者在第一次治疗失败后进行了第二次治疗。所有患者在第 7 天的疼痛缓解率均超过 50%，1 个月和 3 个月随访时，6 例中有 5 例疼痛缓解率超过 50%。
冷冻神经松解术治疗难治性 GON 神经痛是可行的。初步结果令人鼓舞，因为 5/7 例患者在 3 个月的疼痛缓解期受益。
