Preoperative visualization of the greater occipital nerve with magnetic resonance imaging in candidates for occipital nerve decompression for headaches.

Publisher: Nature Publishing Group Country of Publication: England NLM ID: 101563288 Publication Model: Electronic Cited Medium: Internet ISSN: 2045-2322 (Electronic) Linking ISSN: 20452322 NLM ISO Abbreviation: Sci Rep Subsets: MEDLINE

Original Publication: London : Nature Publishing Group, copyright 2011-

Magnetic Resonance Imaging*/methods ; Headache*/diagnostic imaging ; Decompression, Surgical*/methods ; Spinal Nerves*/diagnostic imaging ; Spinal Nerves*/surgery; Humans ; Female ; Male ; Middle Aged ; Adult ; Aged ; Preoperative Care

Occipital nerve decompression is effective in reducing headache symptoms in select patients with migraine and occipital neuralgia. Eligibility for surgery relies on subjective symptoms and responses to nerve blocks and Onabotulinum toxin A (Botox) injections. No validated objective method exists for detecting occipital headache pathologies. The purpose of the study is to explore the potential of high-resolution Magnetic Resolution Imaging (MRI) in identifying greater occipital nerve (GON) pathologies in chronic headache patients. The MRI protocol included three sequences targeting fat-suppressed fluid-sensitive T2-weighted signals. Visualization of the GON involved generating 2-D image slices with sequential rotation to track the nerve course. Twelve patients underwent pre-surgical MRI assessment. MRI identified four main pathologies that were validated against intra-operative examination: GON entanglement by the occipital artery, increased nerve thickness and hyperintensity suggesting inflammation compared to the non-symptomatic contralateral side, early GON branching with rejoining at a distal point, and a connection between the GON and the lesser occipital nerve. MRI possesses the ability to visualize the GON and identify suspected trigger points associated with headache symptoms. This case series highlights MRI's potential to provide objective evidence of nerve pathology. Further research is warranted to establish MRI as a gold standard for diagnosing extracranial contributors in headaches.
(© 2024. The Author(s).)

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VR60350 Vanderbilt Institute for Clinical and Translational Research; 941171 Plastic Surgery Foundation

Keywords: Decompression surgery; Headache surgery; MRI; Migraine surgery; Nerve; Nerve decompression; Neuralgia; Neuropathic pain; Occipital nerve

Date Created: 20240702 Date Completed: 20240702 Latest Revision: 20240705

20240705

PMC11219832

10.1038/s41598-024-65334-4

38956162