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Raj Sundaraj - One of the best experts on this subject based on the ideXlab platform.
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Occipital Nerve Stimulation for the treatment of Occipital Neuralgia‐8 case studies
Pain Medicine, 2006Co-Authors: Charlotte S. H. Johnstone, Raj SundarajAbstract:Objective: The aim was to examine the hypothesis that subcutaneous Occipital stimulation influences pain due to Occipital Neuralgia. Materials and methods: Between 2001 and 2004 8 patients with intractable Occipital Neuralgia were referred to our center. Their records were reviewed. Each patient was interviewed over the telephone. They were all offered a trial of stimulation using a percutaneous lead over one week. If they achieved 50% pain reduction a permanent lead was implanted. The impact of Occipital stimulation was measured by pain score, analgesic requirements and employment status. Results: Seven proceeded to a permanent stimulator. There was a reduction in the visual analogue score post implantation in 5 of the 7 patients. The total quantity of opiates taken after implantation showed a marked reduction. Of the 7 who had a permanent implant 2 acquired full time employment. Conclusion: Occipital Neuralgia is a useful and reversible treatment for intractable Occipital Neuralgia.
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Occipital nerve stimulation for the treatment of Occipital Neuralgia 8 case studies
Pain Medicine, 2006Co-Authors: Charlotte S. H. Johnstone, Raj SundarajAbstract:Objective: The aim was to examine the hypothesis that subcutaneous Occipital stimulation influences pain due to Occipital Neuralgia. Materials and methods: Between 2001 and 2004 8 patients with intractable Occipital Neuralgia were referred to our center. Their records were reviewed. Each patient was interviewed over the telephone. They were all offered a trial of stimulation using a percutaneous lead over one week. If they achieved 50% pain reduction a permanent lead was implanted. The impact of Occipital stimulation was measured by pain score, analgesic requirements and employment status. Results: Seven proceeded to a permanent stimulator. There was a reduction in the visual analogue score post implantation in 5 of the 7 patients. The total quantity of opiates taken after implantation showed a marked reduction. Of the 7 who had a permanent implant 2 acquired full time employment. Conclusion: Occipital Neuralgia is a useful and reversible treatment for intractable Occipital Neuralgia.
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Occipital nerve stimulation for the treatment of Occipital Neuralgia eight case studies
Neuromodulation, 2006Co-Authors: Charlotte S. H. Johnstone, Raj SundarajAbstract:Objective. The aim of this study was to examine the hypothesis that subcutaneous Occipital stimulation influences pain due to Occipital Neuralgia. Materials and Methods. Between 2001 and 2004 eight patients with intractable Occipital Neuralgia were referred to our center. Their records were reviewed. Each patient was interviewed over the telephone. They were all offered a trial of stimulation using a percutaneous lead over 1 week. If they achieved 50% pain reduction a permanent lead was implanted. The impact of Occipital stimulation was measured by pain score, analgesic requirements, and employment status. Results. Seven proceeded to a permanent stimulator. There was a reduction in the visual analog score postimplantation in five of the seven patients. The total quantity of opiates taken after implantation showed a marked reduction. Of the seven who had a permanent implant two acquired full-time employment. Conclusion. Occipital Neuralgia is a useful and reversible treatment for intractable Occipital Neuralgia.
Brandon J. Goff - One of the best experts on this subject based on the ideXlab platform.
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Ultrasound-Guided Greater Occipital Nerve Blocks and Pulsed Radiofrequency Ablation for Diagnosis and Treatment of Occipital Neuralgia
Anesthesiology and pain medicine, 2013Co-Authors: Matthew David Vanderhoek, Hieu T. Hoang, Brandon J. GoffAbstract:Occipital Neuralgia is a condition manifested by chronic Occipital headaches and is thought to be caused by irritation or trauma to the greater Occipital nerve (GON). Treatment for Occipital Neuralgia includes medications, nerve blocks, and pulsed radiofrequency ablation (PRFA). Landmark-guided GON blocks are the mainstay in both the diagnosis and treatment of Occipital Neuralgia. Ultrasound is being utilized more and more in the chronic pain clinic to guide needle advancement when performing procedures; however, there are no reports of ultrasound used to guide a diagnostic block or PRFA of the GON. We report two cases in which ultrasound was used to guide diagnostic greater Occipital nerve blocks and greater Occipital nerve pulsed radiofrequency ablation for treatment of Occipital Neuralgia. Two patients with Occipital headaches are presented. In Case 1, ultrasound was used to guide diagnostic blocks of the greater Occipital nerves. In Case 2, ultrasound was utilized to guide placement of radiofrequency probes for pulsed radiofrequency ablation of the greater Occipital nerves. Both patients reported immediate, significant pain relief, with continued pain relief for several months. Further study is needed to examine any difference in outcomes or morbidity between the traditional landmark method versus ultrasound-guided blocks and pulsed radiofrequency ablation of the greater Occipital nerves.
Matthew J. Pingree - One of the best experts on this subject based on the ideXlab platform.
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Peripheral Nerve Stimulation for Occipital Neuralgia.
Pain Medicine, 2020Co-Authors: Vafi Salmasi, Oludare O. Olatoye, Abdullah Sulieman Terkawi, Jennifer M. Hah, Einar Ottestad, Matthew J. PingreeAbstract:BACKGROUND Chronic headaches are the second most prevalent disease and second most common cause for years lived with disability worldwide. Occipital Neuralgia can cause headaches or be present in addition to other more prevalent causes of headache. If these headaches fail to respond to conservative and pharmacological therapy, physicians proceed to more invasive treatments, starting with infiltration of the greater Occipital nerve with local anesthetic with or without corticosteroids, followed by nerve ablation or stimulation. Occipital nerve stimulation gained more popularity as the technology improved and more pain physicians received training on interventional procedures. METHODS In this manuscript, we are presenting our experience with ultrasound-guided implant of Occipital nerve stimulators using peripheral nerve stimulator systems. After confirming appropriateness of treatment by a successful Occipital nerve block (i.e., resulting in >50% relief in patients' pain intensity), we implanted five stimulator systems in three patients (two bilateral). RESULTS We followed these patients for an average of eight months, and the average pain reduction was ∼50%. We did not observe any adverse events during or immediately after surgery. One patient developed an adverse reaction to the adhesive of the battery transmitter, but it was not severe enough to stop her from using the stimulator. CONCLUSIONS Considering the ease of implant and minimal side effects, implant of peripheral nerve stimulators to stimulate the Occipital nerve is a promising treatment modality for patients with chronic headache who present with features of Occipital Neuralgia. However, wider use of this treatment modality is subject to further studies.
Nicholas M. Boulis - One of the best experts on this subject based on the ideXlab platform.
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Occipital Nerve Stimulation for the Treatment of Refractory Occipital Neuralgia: A Case Series.
World neurosurgery, 2017Co-Authors: Orion P. Keifer, Ashley N. Diaz, Melissa Campbell, Yarema B. Bezchlibnyk, Nicholas M. BoulisAbstract:Background Occipital Neuralgia is a chronic pain syndrome characterized by sharp, shooting pains in the distribution of the Occipital nerves. Although relatively rare, it associated with extremely debilitating symptoms that drastically affect a patient's quality of life. Furthermore, it is extremely difficult to treat as the symptoms are refractory to traditional treatments, including pharmacologic and procedural interventions. A few previous case studies have established the use of a neurostimulation of the Occipital nerves to treat Occipital Neuralgia. Objective The following expands on that literature by retrospectively reviewing the results of Occipital nerve stimulation in a relatively large patient cohort (29 patients). Methods A retrospective review of 29 patients undergoing Occipital nerve stimulation for Occipital Neuralgia from 2012 to 2017 at a single institution with a single neurosurgeon. Results Of those 29 patients, 5 were repair or replacement of previous systems, 4 did not have benefit from trial stimulation, and 20 saw benefit to their trial stage of stimulation and went on to full implantation. Of those 20 patients, even with a history of failed procedures and pharmacological therapies, there was an overall success rate of 85%. The average preoperative 10-point pain score dropped from 7.4 ± 1.7 to a postoperative score of 2.9 ± 1.7. However, as with any peripheral nerve stimulation procedure, there were complications (4 patients), including infection, hardware erosion, loss of effect, and lead migration, which required revision or system removal. Conclusion Despite complications, the results suggest, overall, that Occipital nerve stimulation is a safe and effective procedure for refractory Occipital Neuralgia and should be in the neurosurgical repertoire for Occipital Neuralgia treatment.
Byung-chul Son - One of the best experts on this subject based on the ideXlab platform.
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Referred Trigeminal Facial Pain from Occipital Neuralgia Occurring Much Earlier than Occipital Neuralgia.
Case reports in neurological medicine, 2020Co-Authors: Byung-chul SonAbstract:We report a very rare case in which a patient believed to have auriculotemporal Neuralgia due to the repeated recurrence of paroxysmal stabbing pain in the preauricular temporal region for four years developed Occipital Neuralgia, which finally improved with decompression of the greater Occipital nerve (GON). The pain of Occipital Neuralgia has been suggested to be referred to the frontoorbital (V1) region through trigeminocervical interneuronal connections in the trigeminal spinal nucleus. However, the reports of such cases are very rare. In Occipital Neuralgia, the pain referred to the ipsilateral facial trigeminal region reportedly also occurs in the V2 and V3 distributions in addition to that in the V1 region. In the existing cases of referred trigeminal pain from Occipital Neuralgia, continuous aching pain is usually induced, but in the present case, typical neuralgic pain was induced and diagnosed as idiopathic auriculotemporal Neuralgia. In addition, recurrent trigeminal pain occurred for four years before the onset of Occipital Neuralgia. If the typical Occipital Neuralgia did not develop in four years, it would be impossible to infer an association with the GON. This case shows that the clinical manifestations of referred trigeminal pain caused by the sensitization of the trigeminocervical complex by chronic entrapment of the GON can be very diverse.
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V2 Trigeminal Referred Pain from Chronic Occipital Neuralgia Caused by Entrapment of the Greater Occipital Nerve
Indian Journal of Neurosurgery, 2019Co-Authors: Chang-ik Lee, Byung-chul SonAbstract:AbstractAlthough entrapment of the greater Occipital nerve (GON) is a well-known cause of Occipital Neuralgia, occurrence of referred hemifacial trigeminal pain involving V2 distribution from chronic Occipital Neuralgia is rare. A 67-year-old female patient with intermittent left-sided Occipital Neuralgia of 10-year duration presented with a new onset of left-sided hemifacial pain of 5-month duration. With aggravation of left-sided Occipital Neuralgia, continuous burning pain and paresthesia gradually developed in her left malar and periorbital area. They also spread to her left upper lip. Severe compression of the left GON by tendinous aponeurotic attachment of the trapezius was found intraoperatively. Decompression of the left GON from chronic entrapment resulted in immediate relief for her hemifacial pain and chronic Occipital Neuralgia. These findings provide clinical affirmation of the existence of trigeminal/cervical convergence and hypersensitivity. Chronic irritating afferent input of Occipital Neuralgia caused by entrapment of the GON seems to be associated with sensitization and hypersensitivity of the second-order neurons in the trigeminocervical complex receiving convergent input from dural and cervical structures. Referred trigeminal pain from chronic Occipital Neuralgia may extend to V2 in addition to V1 trigeminal distribution.
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Hemifacial Trigeminal Pain Referred from Occipital Neuralgia Due to Compression of the Greater Occipital Nerve by the Occipital Artery.
Central European Neurosurgery, 2018Co-Authors: Jin-gyu Choi, Byung-chul SonAbstract:Although pathologic vascular contact between the Occipital artery and the greater Occipital nerve (GON) at the crossing point in the nuchal subcutaneous layer can cause Occipital Neuralgia, referred hemifacial trigeminal pain from chronic Occipital Neuralgia owing to this cause is extremely rare. A 61-year-old female patient with left-sided Occipital Neuralgia for 4 years presented with a new onset of left-sided hemifacial pain. Decompression of the left GON from pathologic contacts with the Occipital artery resulted in immediate relief for hemifacial pain and chronic Occipital Neuralgia. The present case implies that sensitization and hyperactivity of the trigeminocervical complex that receives the convergent input from trigeminal and high cervical Occipital nociceptive pathways can be a pathogenic mechanism in referred hemifacial pain from Occipital Neuralgia. In the present case, a branching tributary of the Occipital artery at the crossing point forming a constricting loop above the course of the GON was found to be the cause of entrapment. Because the Occipital artery is reported to be consistently located superficial to the GON at the crossing point, a spatial relationship between the Occipital artery and the GON rather than a mere adhesion or contact might have pathologic significance in the development of Occipital Neuralgia.
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Hemifacial Pain and Hemisensory Disturbance Referred from Occipital Neuralgia Caused by Pathological Vascular Contact of the Greater Occipital Nerve.
Case reports in neurological medicine, 2017Co-Authors: Byung-chul Son, Jin-gyu ChoiAbstract:Here we report a unique case of chronic Occipital Neuralgia caused by pathological vascular contact of the left greater Occipital nerve. After 12 months of left-sided, unremitting Occipital Neuralgia, a hypesthesia and facial pain developed in the left hemiface. The decompression of the left greater Occipital nerve from pathological contacts with the Occipital artery resulted in immediate relief for hemifacial sensory change and facial pain, as well as chronic Occipital Neuralgia. Although referral of pain from the stimulation of Occipital and cervical structures innervated by upper cervical nerves to the frontal head of V1 trigeminal distribution has been reported, the development of hemifacial sensory change associated with referred trigeminal pain from chronic Occipital Neuralgia is extremely rare. Chronic continuous and strong afferent input of Occipital Neuralgia caused by pathological vascular contact with the greater Occipital nerve seemed to be associated with sensitization and hypersensitivity of the second-order neurons in the trigeminocervical complex, a population of neurons in the C2 dorsal horn characterized by receiving convergent input from dural and cervical structures.
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Intractable Occipital Neuralgia caused by an entrapment in the semispinalis capitis.
Journal of Korean Neurosurgical Society, 2013Co-Authors: Byung-chul Son, Deok-ryeong Kim, Sang Won LeeAbstract:Occipital Neuralgia is a rare pain syndrome characterized by periodic lancinating pain involving the Occipital nerve complex. We present a unique case of entrapment of the greater Occipital nerve (GON) within the semispinalis capitis, which was thought to be the cause of Occipital Neuralgia. A 66-year-old woman with refractory left Occipital Neuralgia revealed an abnormally low-loop of the left posterior inferior cerebellar artery on the magnetic resonance imaging, suggesting possible vascular compression of the upper cervical roots. During exploration, however, the GON was found to be entrapped at the perforation site of the semispinalis capitis. There was no other compression of the GON or of C1 and C2 dorsal roots in their intracranial course. Postoperatively, the patient experienced almost complete relief of typical neuralgic pain. Although Occipital Neuralgia has been reported to occur by stretching of the GON by inferior oblique muscle or C1-C2 arthrosis, peripheral compression in the transmuscular course of the GON in the semispinalis capitis as a cause of refractory Occipital Neuralgia has not been reported and this should be considered when assessing surgical options for refractory Occipital Neuralgia.
