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Research ArticleSPINE

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

Vibhu Kapoor, William E. Rothfus, Stephen Z. Grahovac, Stephen Z. Amin Kassam and Michael B. Horowitz
American Journal of Neuroradiology November 2003, 24 (10) 2105-2110;
Vibhu Kapoor
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William E. Rothfus
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Stephen Z. Grahovac
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Stephen Z. Amin Kassam
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Michael B. Horowitz
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Article Figures & Data

Figures

  • Fig 1.
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    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.

  • Fig 2.
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    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.

  • Fig 3.
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    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.

  • Fig 4.
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    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.

  • Fig 5.
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    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.

  • Fig 6.
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    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.

  • Fig 7.
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    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.

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American Journal of Neuroradiology: 24 (10)
American Journal of Neuroradiology
Vol. 24, Issue 10
1 Nov 2003
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Cite this article
Vibhu Kapoor, William E. Rothfus, Stephen Z. Grahovac, Stephen Z. Amin Kassam, Michael B. Horowitz
Refractory Occipital Neuralgia: Preoperative Assessment with CT-Guided Nerve Block Prior to Dorsal Cervical Rhizotomy
American Journal of Neuroradiology Nov 2003, 24 (10) 2105-2110;

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Refractory Occipital Neuralgia: Preoperative Assessment with CT-Guided Nerve Block Prior to Dorsal Cervical Rhizotomy
Vibhu Kapoor, William E. Rothfus, Stephen Z. Grahovac, Stephen Z. Amin Kassam, Michael B. Horowitz
American Journal of Neuroradiology Nov 2003, 24 (10) 2105-2110;
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