Wahezi Sayed E, Zar Safwan, Oakes Devin, Naeimi Tahereh, Yerra Sandeep, Downie Sherry A, Abdi Salahadin, Shahgholi Leili, Abd Elsayed Alaa
Department of Pain Medicine, Montefiore Medical Center, Bronx, NY, USA.
Department of Pain Medicine, The University of Texas-MD Anderson Cancer Center, Houston, TX, USA.
Ann Transl Med. 2024 Oct 20;12(5):85. doi: 10.21037/atm-24-72. Epub 2024 Oct 15.
This manuscript presents the challenges of treating various forms of headaches and the potential of interventional techniques targeting the greater occipital nerve (GON) to alleviate the burden on patients. Occipital neuralgia, characterized by stabbing or shooting pain in the base of the skull, is often associated with primary, cervicogenic, or migraine headaches. While occipital nerve blocks offer temporary relief, durable treatment options are limited. Pulsed radiofrequency (PRF) and thermal radiofrequency ablation (TRFA) have shown promise as minimally invasive procedures for long-term treatment. However, GON is not easily identified using ultrasound or fluoroscopic analysis; thereby, minimizing success of proper ablation. Here, the authors provide a percutaneous strategy to localize the GON and maximize lesion performance. We intend to provide an description of staggered bipolar radiofrequency (RF) lesioning and include the use of staggered bipolar lesioning of the GON and stimulation of the semispinalis capitis. We also analyzed the effectiveness and side effects from this ablation, retrospectively.
Patients with chronic refractory GON neuralgia were selected for GON TRFA. A novel double needle technique of sequential electrical stimulation was used to localize the GON and approximate needle to nerve distance. Once the needles were positioned adjacent to the GON, TRFA was performed using a bipolar staggered technique.
Twenty-two patients with GON were treated with TRFA using a novel double needle technique. Seventy-two percent of these patients reported greater than 50% pain relief at both 1 and 6 months following the procedure. The results of our study demonstrate that performing TRFA using the parallel needle bipolar approach separated 8 mm apart produced the most desirable lesion dimensions that may correlate with effective ablation of the GON.
This study demonstrates a new localization and ablation technique to treat refractory headaches. However, larger studies are needed to confirm our findings.
本手稿介绍了治疗各种形式头痛的挑战以及针对枕大神经（GON）的介入技术减轻患者负担的潜力。枕神经痛的特征是颅骨底部刺痛或放射痛，通常与原发性、颈源性或偏头痛有关。虽然枕神经阻滞可提供暂时缓解，但持久的治疗选择有限。脉冲射频（PRF）和热射频消融（TRFA）已显示出作为长期治疗的微创手术的前景。然而，使用超声或荧光镜分析不易识别GON；因此，适当消融的成功率较低。在此，作者提供了一种经皮策略来定位GON并最大化病变效果。我们打算描述交错双极射频（RF）损伤，并包括使用GON的交错双极损伤和头半棘肌的刺激。我们还回顾性分析了这种消融的有效性和副作用。
选择慢性难治性GON神经痛患者进行GON TRFA。使用一种新颖的顺序电刺激双针技术来定位GON并估算针与神经的距离。一旦针定位在GON附近，就使用双极交错技术进行TRFA。
22例GON患者采用新颖的双针技术进行TRFA治疗。这些患者中有72%在术后1个月和6个月时报告疼痛缓解超过50%。我们的研究结果表明，使用相距8 mm的平行针双极方法进行TRFA可产生最理想的病变尺寸，这可能与GON的有效消融相关。
本研究展示了一种治疗难治性头痛的新定位和消融技术。然而，需要更大规模的研究来证实我们的发现。
