Neuroradiology Unit, University Hospital, Grenoble, France.
Radiology Unit, Necker University Hospital, Paris, France.
Neuroradiology. 2024 Feb;66(2):161-178. doi: 10.1007/s00234-023-03273-z. Epub 2023 Dec 30.
Craniofacial pain syndromes exhibit a high prevalence in the general population, with a subset of patients developing chronic pain that significantly impacts their quality of life and results in substantial disabilities. Anatomical and functional assessments of the greater occipital nerve (GON) have unveiled its implication in numerous craniofacial pain syndromes, notably through the trigeminal-cervical convergence complex. The pathophysiological involvement of the greater occipital nerve in craniofacial pain syndromes, coupled with its accessibility, designates it as the primary target for various interventional procedures in managing craniofacial pain syndromes. This educational review aims to describe multiple craniofacial pain syndromes, elucidate the role of GON in their pathophysiology, detail the relevant anatomy of the greater occipital nerve (including specific intervention sites), highlight the role of imaging in diagnosing craniofacial pain syndromes, and discuss various interventional procedures such as nerve infiltration, ablation, neuromodulation techniques, and surgeries. Imaging is essential in managing these patients, whether for diagnostic or therapeutic purposes. The utilization of image guidance has demonstrated an enhancement in reproducibility, as well as technical and clinical outcomes of interventional procedures. Studies have shown that interventional management of craniofacial pain is effective in treating occipital neuralgia, cervicogenic headaches, cluster headaches, trigeminal neuralgia, and chronic migraines, with a reported efficacy of 60-90% over a duration of 1-9 months. Repeated infiltrations, neuromodulation, or ablation may prove effective in selected cases. Therefore, reassessment of treatment response and efficacy during follow-up is imperative to guide further management and explore alternative treatment options. Optimal utilization of imaging, interventional techniques, and a multidisciplinary team, including radiologists, will ensure maximum benefit for these patients.
颅面部疼痛综合征在普通人群中发病率较高，其中一部分患者发展为慢性疼痛，严重影响其生活质量，并导致严重残疾。对枕大神经（GON）的解剖学和功能评估揭示了其在许多颅面部疼痛综合征中的作用，特别是通过三叉-颈脊神经汇聚复合体。颅面部疼痛综合征中枕大神经的病理生理参与，加上其可及性，将其指定为治疗颅面部疼痛综合征的各种介入程序的主要目标。本教育综述旨在描述多种颅面部疼痛综合征，阐明 GON 在其病理生理学中的作用，详细描述枕大神经的相关解剖结构（包括特定的介入部位），强调影像学在诊断颅面部疼痛综合征中的作用，并讨论各种介入程序，如神经浸润、消融、神经调节技术和手术。影像学在管理这些患者中至关重要，无论是诊断还是治疗目的。图像引导的应用已证明可以提高介入程序的可重复性以及技术和临床效果。研究表明，颅面部疼痛的介入管理对于治疗枕大神经痛、颈源性头痛、丛集性头痛、三叉神经痛和慢性偏头痛有效，在 1-9 个月的时间内报告的有效率为 60-90%。在选定的病例中，重复浸润、神经调节或消融可能有效。因此，在随访期间重新评估治疗反应和疗效对于指导进一步管理和探索替代治疗方案至关重要。最佳利用影像学、介入技术和多学科团队，包括放射科医生，将确保为这些患者带来最大的收益。
