枕大神经痛的封闭治疗

目的通过对12具成人头颈部尸体标本的解剖,对临床上确诊为枕大神经痛的12例病人,在枕大神经行程中易卡压的部位,进行局部封闭治疗,观察治疗结果。方法根据病因在不同部位用2%利多卡因5mL、确炎舒松A30mg混悬液进行局部封闭治疗。对有颈椎劳损退变的病人(本组6例),进行第2颈椎横突内后方“入肌点”进行封闭;对有感冒及遭受风寒侵袭者进行枕大神经“浅出皮下点”封闭(本组4例);对有外伤引起者(本组2例),行上述两处封闭,并同时予枕颌带牵引。随访观察治疗效果。结果本组12例,注射后疼痛完全消失,随访3个月无复发5例,占41.5%。注射后疼痛大部分消失6例,占50%。注射后症状无明显改善1例,占8.5%。结论局部封闭治疗枕大神经痛,只要注射部位准确,注射方法得当,可以取得良好疗效。     

穴位注射治疗枕大神经痛38例

在门诊头痛病人中有部份病人表现枕部和后颈部发作性剧痛,当咳嗽、喷嚏、头部活动时疼痛加重、颈部活动不利、头微前倾或侧倾。查体：在枕外粗隆与乳突连线中点稍内侧（即枕大神经穿出皮下处）有压痛,风池穴有深压痛,压痛点可向枕颈部放射,部分病人在枕大神经出分布区尚有感觉过敏或感觉减退,以上即是枕大神经痛的典型表现。笔者对原发性38例枕大神经痛采用穴位注射治疗,取得了满意疗效,现报告如下：     

针刀松解治疗枕大神经痛临床观察

我院2002年元月~2004年12月疼痛门诊对方便随访的86例枕大神经痛患者随机分为针刀松解组和神经阻滞组进行对照观察,现将结果报告如下:1临床资料1.1一般资料:86例枕大神经痛患者,男34例,女52例,年龄27~63岁,平均48.2岁。病程1月~4年。左侧枕大神经痛26例,右侧枕大神经42例,双侧枕大神经痛18例。随机分为针刀松解组和神经阻滞组,每组43例。1.2治疗方法[1]:①神经阻滞:病人骑坐在治疗椅上,双前臂重叠放在椅背上,额部置于前臂上,在枕大神经出筋膜点即枕骨粗隆与乳突连线中点(相当于风池穴)的压痛点为治疗点,用5号齿科针垂直皮面进针,直达枕骨,注…     

手术松解治疗顽固性枕大神经痛

目的探讨枕大神经松解术治疗顽固性枕大神经痛的疗效。方法1998年3月～2005年8月，收治26例保守治疗无效的顽固性枕大神经痛患者。男12例，女14例；年龄38～63岁，平均52岁。病程3～7年。16例有长期低头工作史，5例有外伤史，余无明显诱因。视觉模拟评分法（visual analogue scales，VAS）评分6．O～9．5分，平均8．6分。7例全麻下行头下斜肌切断松解枕大神经，19例局麻下行枕大神经松解。术中10例切除肿物并行病理检查。结果26例术后疼痛明显缓解或消失，切口均I期愈合。病理检查：淋巴结3例，神经鞘瘤2例，瘢痕压迫5例。术后3dVAS评分为0～5分，平均2分。23例获随访1～3年。术后1个月VAS评分为0～4．5分，平均1．9分。其中2例复发，症状较术前减轻，未再行手术探查；6例劳累后疼痛略加重，口服消炎镇痛类药物或理疗后可缓解；余患者无复发。结论对枕大神经行彻底松解，包括头下斜肌的切断、斜方肌与头半棘肌间松解、浅出斜方肌与骨纤维管处松解，使其走行过程中无任何压迫，是治疗顽固性枕大神经痛的关键。     

局部阻滞加手法治疗枕神经痛

几年来作者单用局部阻滞与局部阻滞加手法治疗枕神经痛 ,并进行了疗效随访 ,报告如下。临床资料　本组共 72例随机分两组 ,治疗组 36例 ,男 14例 ,女 2 2例 ,年龄 16～ 6 8岁 ,平均 39.5岁 ,病程 2 0天～ 10年 ,平均 2 .1年 ,单侧枕神经痛 2 3例 ,双侧 13例 ;对照组 36例 ,男 13例 ,女 2 3例 ,年龄 18～ 6 6岁 ,平均 40 .2岁 ,病程 2 2天～ 9年 ,单侧枕神经痛 2 5例 ,双侧 11例。临床表现　本组患者具典型枕神经痛的症状 :枕大神经痛表现为一侧枕下痛 ,并向枕顶部放射 ;枕小神经痛为乳突稍后缘痛 ,并向耳后、甚至前额及眼眶区放射。查体 :枕…     

中西医结合治疗颈性枕神经痛28例报告

中西医结合治疗颈性枕神经痛２８例报告陕俊平由颈部骨、软组织病变引起的枕神经痛统称为颈性枕神经痛。笔者自１９８７～１９９３年采取中西医结合治疗颈性枕神经痛２８例，疗效满意，现报告如下。１临床资料１．１一般资料本组２８例，男１６例，女１２例；年龄３６～７...     

枕大孔前区脑膜瘤的显微外科治疗

位于枕大孔前缘、延髓腹侧的肿瘤约占所有颅内肿瘤的 1% ,其中 6 1%～76 %为脑膜瘤[1] 。由于该类肿瘤常推移、扭曲延髓及上颈髓 ,且与重要的神经血管结构关系密切 ,手术治疗难度大、风险高。我科 1995年 3月～ 2 0 0 0年 12月行显微手术切除该类肿瘤 9例 ,效果满意 ,现报告如下。1.一般临床资料 :本组男 3例 ,女 6例 ;年龄 37～ 6 2岁 ,平均 5 0岁 ;病程 3～72个月 ,平均 2 5个月 ;表现为颈部疼痛6例次 ,肢体感觉障碍 5例次 ,肢体肌力下降或肌肉萎缩 5例次 ,肌张力亢进或出现病理征 7例次 ,小脑功能障碍 4例次 ,后组颅神经麻痹 3例次 ,呼吸…     

痛点注射治疗枕神经痛50例报告

痛点注射治疗枕神经痛５０例报告郑炳林，潘水英枕神经痛是一种比较常见的顽固性头痛，其治疗方法很多，但效果不够理想。笔者自１９８９年一１９９３年采用枕部痛点注射法治疗枕神经痛５０例，效果满意，现报告如下：临床资料本组５０例，男２３例，女２７例；年龄１６岁...     

电凝法治疗腱鞘囊肿82例

腱鞘囊肿是临床上较为常见的一种疾病.传统的治疗方法：非手术治疗或手术治疗.前者易复发,后者局部会遗留不同程度的瘢痕,影响其外观.我们根据组织被电凝烧灼后的变化,应用电凝法治疗腱鞘囊肿82例,取得了满意的效果.     

枕大孔区脑膜瘤的显微外科手术治疗

脑膜瘤是枕大孔区最常见的良性肿瘤。我院自1994年4月至2002年12月共收治枕大孔区肿瘤30例，占同期颅内肿瘤的0．61％，其中脑膜瘤10例，均接受显微神经外科手术治疗并获得了较好的疗效。现总结报道如下。     

Headaches in patients with radiosurgically treated occipital arteriovenous malformations

OBJECT: The goal of this study was to determine the prevalence, characteristics, and radiosurgical outcomes of headaches associated with occipital arteriovenous malformations (AVMs). METHODS: The authors reviewed the medical records of 37 consecutive patients with occipital AVMs who had been treated by radiosurgery to identify the radiological features of the AVMs before and after treatment and the clinical features and outcomes of headaches described in accordance with the criteria of the International Headache Society (IHS). Thirty-six patients (97.3%) were followed for a mean period of 46.6 months. The median volume of the AVMs was 1.9 cm3, to which a mean radiation dose of 21.6 Gy was delivered. In the entire study group, periodic headaches were found in 17 patients (45.9%), of whom seven (18.9%) suffered from migraines with the characteristic visual aura. Migraine was predominantly found in patients with right-sided (p = 0.038) or laterally located (p = 0.025) AVMs. Factors associated with a higher incidence of any type of headache included larger nidus volume (p = 0.02), tortuous change of feeding artery (p = 0.036), and cortical drainage with reflux in the superior sagittal sinus (p = 0.032). The actuarial rate of angiographic obliteration was 71.6% at 3 years. Headaches resolved or improved in 12 (70.6%) of 17 patients, including six (85.7%) of seven with migraine. The outcome of headache closely correlated with the obliteration results of the AVM (p = 0.002). CONCLUSIONS: A portion of occipital AVMs do cause headaches that satisfy the current IHS criteria for migraine, and the prevalence varies by the topography of the lesion. Radiosurgery can resolve headaches in the majority of treated patients.     

针刀治疗枕神经痛30例疗效观察

枕神经痛多表现为单侧头痛,所以临床上很容易被误诊为血管神经性头痛（偏头痛）。关于本病的病因,文献报道不多。非药物治疗（含针灸、按摩、针刀等）对本病有效,但有效率、痊愈率报道不一,且既往文献报道多侧重于观察近期疗效,对远期疗效的报道不多。2007年至2008年对30例枕神经痛患者针刀治疗后的近期与远期疗效进行观察,现报告如下．     

枕角穿刺尿激酶灌注治疗脑室出血

脑室出血是临床上常见的急症之一．如果不采取适当的治疗手段．往往危及生命．本院近5年来采用枕角穿刺结合尿激酶灌注引流治疗脑室出血，取得满意的结果．使患者症状明显改善，死亡率、致残率下降．生活质量提高。现报告分析如下。     

Myofascial pain may present clinically as occipital neuralgia

Three case presentations illustrate that the clinical signs and symptoms of occipital neuralgia may be produced by myofascial pain. Assessment of myofascial trigger points is needed before making a diagnosis of occipital neuralgia. Myofascial trigger points can be effectively treated with minimally invasive procedures, thereby avoiding irreversible surgical interventions.     

Symptomatic cavernous hemangioma of the occipital condyle treated with methacrylate embolization.

BACKGROUND: Cavernous hemangiomas of the cranial base are rare tumors. No case of symptomatic intraosseous angioma affecting the occipital condyle has been reported. This particular case was treated with surgical embolization using acrylic resin.CASE DESCRIPTION: A 20-year-old man with a 1-year history of neck pain and torticollis was referred to our hospital. Neuroradiological examination revealed the typical picture of an intraosseous cavernous hemangioma located in the right occipital condyle. The patient was operated through a suboccipital approach. Biopsy and direct embolization with methacrylate was performed. The definitive pathological diagnosis confirms the neuro-radiological suspicion of intraosseous cavernous hemangioma. The follow-up of the patient (4 years) revealed no recurrence of pain or abnormal posture.CONCLUSIONS: A rare case of cranial base cavernous hemangioma is reported. Methacrylate embolization can be a good option for the treatment of this uncommon lesion.     

CT-guided infiltration of greater occipital nerve for refractory craniofacial pain syndromes other than occipital neuralgia

PurposeThe purpose of this study was to evaluate the effectiveness of computed tomography (CT)-guided infiltration of greater occipital nerve (GON) for the treatment of refractory craniofacial pain syndromes other than occipital neuralgia.Materials and methodsFifty-six patients suffering from refractory craniofacial pain syndromes were included between 2011 and 2017. There were 33 women and 23 men with a mean age of 50.7 years ± 13.1 (SD) (range: 27–74 years). CT-guided infiltration was performed at the intermediate site of the GON with local anesthetics and cortivazol. Twenty-six (26/56; 46%) patients suffered from chronic migraine, 14 (14/56; 25%) from trigeminal neuralgia and 16 (16/56; 29%) from cluster headaches. Clinical success at 1, 3, and 6 months was defined by a decrease of at least 50% of pain as assessed using visual analog scale (VAS).ResultsMean overall VAS score before infiltration was 8.7 ± 1.3 (SD) (range: 6 - 10). Mean overall VAS scores after infiltration were 2.3 ± 3 (SD) (range: 0 - 10) (P < 0.01) at one month, 3.5 ± 3.3 (SD) (range: 0 - 10) (P < 0.01) at three months and 7.6 ± 1.3 (SD) (range: 1–10) (P < 0.01) at six months. After infiltration, clinical success was achieved in 44 patients (44/56; 78.5%) at 1 month, 37 patients (37/56; 66%) at 3 months and 13 patients (13/56; 23%) at 6 months. Clinical success according to the clinical presentation were as follows: 88% (23/26) at one month, 73% (19/26) at 3 months, and 23% (6/26) at 6 months in patients with chronic migraine, 81% (13/16), 69% (11/16) and 31% (5/16) in those with cluster headaches and 57% (8/14), 50% (7/14) and 14% (2/14) in those with trigeminal neuralgia. No major complications due to CT-guided GON infiltration were reported in any patient.ConclusionCT-guided infiltration at the intermediate site of the GON appears as an effective treatment of craniofacial pain syndromes especially in patients with chronic migraine and those with cluster headaches.     

Trigeminal neuralgia treated by radiofrequency coagulation

Ninety-six patients underwent percutaneous radiofrequency coagulation (RC) of the Gasserian ganglion for relief of trigeminal neuralgia between 1973 and 1978. Fifty-two percent of patients who were followed for 5 years were free of recurrence after a single RC procedure. Factors predicting clinical results were sought from initial historical and demographic data. Age, sex, duration of illness, and previous response to medication were unrelated to outcome. Patients previously treated by open surgery appeared to receive less benefit from subsequent RC. The RC procedure seemed more effective in the treatment of patients with classical tic douloureux than in those with atypical features. The degree of sensory loss created by RC was associated with the clinical outcome. Patients acquiring dense sensory deficits demonstrated a reduced risk of recurrence (p = 0.006): 25% of patients with dense sensory loss and 55% of those with a partial deficit developed a recurrence by 5 years, whereas all patients without initial sensory loss suffered a recurrence by 5 years.