Abstract
The purpose of this report is to describe the technical aspects of CT-guided C2 dorsal root ganglion diagnostic block and radiofrequency ablation for refractory cervicogenic headache. CT guidance allows precise and safe positioning of a needle adjacent to the C2 dorsal root ganglion. At-risk neural and vascular structures can be avoided with CT, and it can provide a thorough understanding of upper cervical neuroanatomy.
Highlights
Plexus surrounding the C2 dorsal root ganglion (DRG); a small volume (0.2– 0.3 mL) of iohexol (Omnipaque 180; GE Healthcare, Piscataway, New Jersey) 180 or 240 contrast diluted with normal saline should be injected to ensure appropriate positioning and exclude inadvertent arterial or dural puncture
Some authors advocate sacrificing the C2 DRG during surgical C1–C2 fusion because numbness often has no effect on health-related quality of life, unlike neuralgia.[2]
Image-guided injection of the upper cervical spine has been described for treatment of cervicogenic headache, including the atlanto-occipital, atlantoaxial, C2–C3, and C3–C4 facet joints and nerve blocks of C1 through C4
Summary
Note:—RFA indicates radiofrequency ablation; INR, international normalized ratio. a Relative contraindication because preoperative noncontrast MRA may be performed. Note:—RFA indicates radiofrequency ablation; INR, international normalized ratio. A Relative contraindication because preoperative noncontrast MRA may be performed. Plexus surrounding the C2 DRG; a small volume (0.2– 0.3 mL) of iohexol (Omnipaque 180; GE Healthcare, Piscataway, New Jersey) 180 or 240 contrast diluted with normal saline should be injected to ensure appropriate positioning and exclude inadvertent arterial or dural puncture. Once the appropriate position is confirmed, a 1- to 2-mL 1:1 mixture of preservative-free dexamethasone, 10 mg/mL, and 0.5% or 0.75% of bupivacaine is prepared and slowly instilled through the needle. The needle is removed with the stylet in place
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