Greater occipital nerve cryoneurolysis in the management of intractable occipital neuralgia

• DOI: 10.1016/j.neurad.2017.11.002
• Publication Date: 2017-12-19T18:15:28Z
• Authors: Adrian Kastler; Arnaud Attyé; Caroline Maindet; Benjamin Nicot; Emmanuel Gay; Bruno Kastler; Alexandre Krainik
• Keywords: Occipital neuralgia; Refractory (planetary science); Occipital nerve stimulation; Peripheral nerve stimulation

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.