Greater occipital nerve cryoneurolysis in the management of intractable occipital neuralgia.

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 2.0mm cryoprobe was then inserted in the coaxial and sensitive stimulation at 100Hz was performed. One to three freezing cycles were performed in one session. 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.