Advanced

AJNR - American Journal of Neuroradiology

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kapoor, V. Articles by Horowitz, M. B. Search for Related Content PubMed PubMed Citation Articles by Kapoor, V. Articles by Horowitz, M. B.

Refractory Occipital Neuralgia: Preoperative Assessment with CT-Guided Nerve Block Prior to Dorsal Cervical Rhizotomy

Vibhu Kapoor^a, William E. Rothfus^a, Stephen Z. Grahovac^a, Stephen Z. Amin Kassam^b and Michael B. Horowitz^b

^a Division of Neuroradiology, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
^b Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA

View larger version (24K): [in a new window]   FIG 1. Left C2 nerve root block. Axial CT at level of C2 vertebral body demonstrates final location of tip of 25-gauge spinal needle (arrow) posterior to lateral mass (open arrow) of C2 vertebra.

View larger version (24K): [in a new window]   FIG 2. Three-dimensional illustration of left C2 nerve root block, posterosuperior view. Posterior arch of C1 has been removed for clarity. C2 nerve is depicted in yellow, vertebral artery in red and injected medication in green.

View larger version (17K): [in a new window]   FIG 3. Left C3 nerve root block. Axial CT at level of C2–C3 intervertebral foramen demonstrates final location of tip of 25-gauge spinal needle (arrow) anterior to superior articular facet of C3.

View larger version (17K): [in a new window]   FIG 4. Three-dimensional illustration of left C2 nerve root block viewed from above. Posterior arches of C1 and C2 have been removed for clarity. C3 nerve is depicted in yellow and injected medication in green. Note vertebral artery (red) just anterior to the nerve. D, dens.

View larger version (36K): [in a new window]   FIG 5. Composite 3D illustration of left C2 (white arrow) and C3 (black arrow) nerve root block viewed from left. Vertebral artery (A) runs close to C3 nerve. Note connections between C1, C2, and C3 nerves. G, greater occipital nerve.

View larger version (36K): [in a new window]   FIG 6. Right C2 nerve root block. Iodinated contrast medium (arrow) is injected before injection of bupivacaine to confirm accurate placement of needle tip. Arrowhead marks foramina transversaria that transmits vertebral artery and veins.

View larger version (131K): [in a new window]   FIG 7. Illustration of occipital region and upper cervical vertebrae viewed from behind showing course of greater occipital nerve (G) with possible sites of compression: F, due to atlantoaxial joint disease; M, as it penetrates tendinous portion of the trapezius muscles (Z); T, as occipital nerve pierces posterior atlantoaxial membrane (depicted in light semitransparent blue); and between posterior arches of C1 and C2 vertebrae. Note connections between greater occipital nerve (G) and C1 (i) and C3 (ii) nerves. O, occipital bone.