The Experts below are selected from a list of 1371 Experts worldwide ranked by ideXlab platform
Milan Adamus - One of the best experts on this subject based on the ideXlab platform.
-
pulsed radiofrequency therapy versus Greater Occipital Nerve block in the management of refractory cervicogenic headache a pilot study
Prague medical report, 2011Co-Authors: Tomas Gabrhelik, Pavel Michalek, Milan AdamusAbstract:The aim of this pilot study was to compare the efficacy of pulsed radiofrequency to the Greater Occipital Nerve versus a Greater Occipital Nerve block with a mixture of local anaesthetic and steroid in the management of refractory cervicogenic headache. We enrolled 30 patients suffering from refractory cervicogenic headache. Patients were randomly allocated into two groups of fifteen. A Greater Occipital Nerve block with steroid was utilised in group A, while a pulsed radiofrequency treatment was employed in group B. Success of both procedures was evaluated by comparing pre and post intervention Visual Analogue Scale of pain, Medication Quantification Scale - III. and Global Perceived Effect at three and 9 months after the procedures. At three months post therapy a significant decrease in Visual Analogue Scale (p<0.001) was identified (3.2 points in group A, 3.3 points in group B respectively). In group B pain remained reduced even after 9 months (p<0.001) when compared to pre treatment scores. The consumption of analgesic medication was reduced significantly in both groups at three months (p<0.001) and 9 months (p<0.01), respectively. No serious complication was noted. Greater Occipital Nerve block is a safe, efficient technique in the management of cervicogenic headaches. Despite the lack of high quality scientific evidence (level III or IV) in the literature, we have extensive experience with steroid application and pulsed radiofrequency to the Greater Occipital Nerve and report the beneficial results in our study.
-
Pulsed radiofrequency therapy versus Greater Occipital Nerve block in the management of refractory cervicogenic headache - a pilot study.
Prague medical report, 2011Co-Authors: Tomas Gabrhelik, Pavel Michalek, Milan AdamusAbstract:The aim of this pilot study was to compare the efficacy of pulsed radiofrequency to the Greater Occipital Nerve versus a Greater Occipital Nerve block with a mixture of local anaesthetic and steroid in the management of refractory cervicogenic headache. We enrolled 30 patients suffering from refractory cervicogenic headache. Patients were randomly allocated into two groups of fifteen. A Greater Occipital Nerve block with steroid was utilised in group A, while a pulsed radiofrequency treatment was employed in group B. Success of both procedures was evaluated by comparing pre and post intervention Visual Analogue Scale of pain, Medication Quantification Scale - III. and Global Perceived Effect at three and 9 months after the procedures. At three months post therapy a significant decrease in Visual Analogue Scale (p
-
pulsed radiofrequency therapy versus Greater Occipital Nerve block in the management of refractory cervicogenic headache a pilot study
Prague medical report, 2011Co-Authors: Tomas Gabrhelik, Pavel Michalek, Milan AdamusAbstract:The aim of this pilot study was to compare the efficacy of pulsed radiofrequency to the Greater Occipital Nerve versus a Greater Occipital Nerve block with a mixture of local anaesthetic and steroid in the management of refractory cervicogenic headache. We enrolled 30 patients suffering from refractory cervicogenic headache. Patients were randomly allocated into two groups of fifteen. A Greater Occipital Nerve block with steroid was utilised in group A, while a pulsed radiofrequency treatment was employed in group B. Success of both procedures was evaluated by comparing pre and post intervention Visual Analogue Scale of pain, Medication Quantification Scale - III. and Global Perceived Effect at three and 9 months after the procedures. At three months post therapy a significant decrease in Visual Analogue Scale (p<0.001) was identified (3.2 points in group A, 3.3 points in group B respectively). In group B pain remained reduced even after 9 months (p<0.001) when compared to pre treatment scores. The consumption of analgesic medication was reduced significantly in both groups at three months (p<0.00 1)
Neil Cherian - One of the best experts on this subject based on the ideXlab platform.
-
acute treatment of basilar type migraine with Greater Occipital Nerve blockade
Headache, 2010Co-Authors: Eric P Baron, Maryann Mays, Stewart J Tepper, Neil CherianAbstract:Basilar-type migraine (BTM) precludes use of migraine-specific medications such as triptans and ergots based on concerns originating from the vascular theory of migraine, although data supporting this contraindication are lacking. Availability of effective treatments for acute BTM is limited. We report a case of BTM aborted with Greater Occipital Nerve (GON) blockade given in the setting of prominent subOccipital tenderness. GON blockade may provide an additional option in acute management of BTM. It may be particularly useful when associated with prominent ipsilateral subOccipital tenderness.
-
Acute Treatment of Basilar‐Type Migraine With Greater Occipital Nerve Blockade
Headache, 2010Co-Authors: Eric P Baron, Maryann Mays, Stewart J Tepper, Neil CherianAbstract:Basilar-type migraine (BTM) precludes use of migraine-specific medications such as triptans and ergots based on concerns originating from the vascular theory of migraine, although data supporting this contraindication are lacking. Availability of effective treatments for acute BTM is limited. We report a case of BTM aborted with Greater Occipital Nerve (GON) blockade given in the setting of prominent subOccipital tenderness. GON blockade may provide an additional option in acute management of BTM. It may be particularly useful when associated with prominent ipsilateral subOccipital tenderness.
Mincheol Chang - One of the best experts on this subject based on the ideXlab platform.
-
Management of refractory chronic migraine using ultrasound-guided pulsed radiofrequency of Greater Occipital Nerve: Two case reports.
Medicine, 2018Co-Authors: Soyoung Kwak, Mincheol ChangAbstract:AbstractRationale:Although various oral medications and procedures are applied for managing migraine, their efficacy remains limited. To control migraine that does not respond to conventional treatments, we conducted pulsed radiofrequency (PRF) stimulation to the Greater Occipital Nerve (GON) in 2 p
Manfred Greher - One of the best experts on this subject based on the ideXlab platform.
-
Reply to: Cervical plexus and Greater Occipital Nerve blocks: controversies and technique update.
Regional anesthesia and pain medicine, 2019Co-Authors: Manfred Greher, Bernhard Moriggl, Jens BørglumAbstract:We congratulate Greengrass et al [1][1] with their noteworthy daring discourse concerning the cervical plexus (CP) and the Greater Occipital Nerve (GON) blocks. The detailed description regarding the fact that the CP is a single anatomic entity that can be blocked by an injection of local anesthetic
-
Greater Occipital Nerve Block
Atlas of Ultrasound-Guided Regional Anesthesia, 2019Co-Authors: Manfred GreherAbstract:Abstract Ultrasound-guided Greater Occipital Nerve block at the level of C2 between the semispinalis capitis muscle and the obliquus capitis inferior muscle is selective, precise, and efficient in different types of headache and has advantages compared to the classical block site at the level of the superior nuchal line.
-
Ultrasound-Guided Greater Occipital Nerve Block
Atlas of Ultrasound-Guided Procedures in Interventional Pain Management, 2018Co-Authors: Bernhard Moriggl, Manfred GreherAbstract:Blocks of the Greater Occipital Nerve (GON) have been performed without target visualization for a long time, based on surface landmarks only. An ultrasound (US)-guided technique was first introduced by our group in 2010 [1]. GON blocks are effective not only in the treatment of Occipital neuralgia, which is a relatively rare pathology, but also for other types of headache and even facial pain. Studies confirm pain relief in migraine [2, 3], cervicogenic headache [4], cluster headache [5, 6], and even post-dural puncture headache [7] but show no improvement in chronic tension-type headache [8]. Additionally, they can have a positive effect in trigeminal neuralgia but show no benefit in persistent idiopathic facial pain [9]. Convergence of cervical and trigeminal input seems to be the explanation for this phenomenon, as experimental stimulation of the GON increases metabolic activity both in the trigeminal caudal nucleus and in the cervical dorsal horn [10]. Because of their wide field of indications, GON blocks are performed frequently by pain physicians.
Bruno Kastler - One of the best experts on this subject based on the ideXlab platform.
-
Greater Occipital Nerve infiltration under MR guidance: Feasibility study and preliminary results
European Radiology, 2018Co-Authors: Adrian Kastler, Bruno Kastler, Romain Perolat, Caroline Maindet-dominici, Jan Fritz, Alim Louis Benabid, Stephan Chabardes, Alexandre KrainikAbstract:To assess the feasibility of Greater Occipital Nerve (GON) intermediate site infiltration with MRI guidance. Eleven consecutive patients suffering from chronic refractory cranio-facial pain who underwent 16 GON infiltrations were included in this prospective study. All of the procedures were performed on an outpatient basis in the research facility of our institution, with a 1.5 T scanner. The fatty space between inferior obliquus and semispinalis muscles at C1-C2 level was defined as the target. Technical success was defined as the ability to accurately inject the products at the target, assessed by post-procedure axial and sagittal proton density-weighted sequences. Clinical success was defined as a 50% pain decrease at 1 month. Technical success was 100%. GON was depicted in 6/11 cases on planning MRI sequences. Mean duration of procedure was 22.5 min (range 16-41). Clinical success was obtained in 7/11 included patients (63.6%) with a mean self-reported improvement of 78%. Interventional MR-guidance for GON infiltration is a feasible technique offering similar results to an already established effective procedure. It may appear as a useful tool in specific populations, such as young patients and repeat infiltrations, and should be considered in these settings.
-
Greater Occipital Nerve cryoneurolysis in the management of intractable Occipital neuralgia
Journal of Neuroradiology, 2017Co-Authors: Adrian Kastler, Bruno Kastler, Arnaud Attyé, Caroline Maindet, Benjamin Nicot, Alexandre KrainikAbstract:Abstract Objective To assess technical feasibility of cryoneurolysis of the Greater Occipital Nerve in the management of Occipital neuralgia. Methods 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 2.0 mm cryoprobe was then inserted in the coaxial and sensitive stimulation at 100 Hz was performed. One to three freezing cycles were performed in one session. Results 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. Conclusion 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.
-
Ultrasound-Guided Intermediate Site Greater Occipital Nerve Infiltration: A Technical Feasibility Study.
Pain physician, 2016Co-Authors: Jonathan Zipfel, Adrian Kastler, Laurent Tatu, Julien Behr, Rachid Kechidi, Bruno KastlerAbstract:BACKGROUND Two studies recently reported that computed tomography (CT) guided infiltration of the Greater Occipital Nerve at its intermediate site allows a high efficacy rate with long-lasting pain relief following procedure in Occipital neuralgia and in various craniofacial pain syndromes. OBJECTIVE The purpose of our study was to evaluate the technical feasibility and safety of ultrasound-guided intermediate site Greater Occipital Nerve infiltration. STUDY DESIGN Retrospective study. SETTING This study was conducted at the imaging department of a 1,409 bed university hospital. METHODS Local institutional review board approval was obtained and written consent was waived. In this retrospective study, 12 patients suffering from refractory Occipital neuralgia or craniofacial pain syndromes were included between April and October 2014. They underwent a total of 21 ultrasound-guided infiltrations. Infiltration of the Greater Occipital Nerve was performed at the intermediate site of the Greater Occipital Nerve, at its first bend between obliqus capitis inferior and semispinalis capitis muscles with local anestetics and cortivazol. Technical success was defined as satisfactory diffusion of added iodinated contrast media in the fatty space between these muscles depicted on control CT scan. We also reported first data of immediate block test efficacy and initial clinical efficacy at 7 days, one month, and 3 months, defined by a decrease of at least 50% of visual analog scale (VAS) scores. RESULTS Technical success rate was 95.24%. Patients suffered from right unilateral Occipital neuralgia in 3 cases, left unilateral Occipital neuralgia in 2 cases, bilateral Occipital neuralgia in 2 cases, migraine in one case, cervicogenic headache in one case, tension-type headache in 2 cases, and cluster headache in one case. Block test efficacy was found in 93.3% (14/15) cases. Clinical efficacy was found in 80% of cases at 7 days, in 66.7% of cases at one month and in 60% of cases at 3 months. No major complications were noted. LIMITATIONS Some of the limitations of our study include that it represents a single institution. The low number of infiltrations included in this study, for this guidance procedure, is another bias. CONCLUSIONS This ultrasound-guided infiltration technique appears to be feasible, safe, non-ionizing, and fast when targeting the Greater Occipital Nerve in its intermediate portion. This imaging guidance modality should be used in routine clinical practice. KEY WORDS Greater Occipital Nerve, infiltration, ultrasound guidance, corticosteroids, Occipital neuralgia, craniofacial pain syndrome.
-
A simplified CT-guided approach for Greater Occipital Nerve infiltration in the management of Occipital neuralgia
European radiology, 2015Co-Authors: Adrian Kastler, Yannick Onana, Alexandre Comte, Arnaud Attyé, Jean-louis Lajoie, Bruno KastlerAbstract:Objectives To evaluate the efficacy of a simplified CT-guided Greater Occipital Nerve (GON) infiltration approach in the management of Occipital neuralgia (ON).
