This protocol addresses the clinical situation in which the prior line of minimally invasive, reversible procedures failed to provide adequate relief. Those procedures included:
Goal not reached: at least 50% relief of occipital pain — the threshold required to proceed to permanent ONS implantation or to consider the prior line successful.
When the reversible procedures above have not provided sufficient relief, the protocol turns to surgical and ablative interventions directed at the occipital nerve. These are more definitive in nature than the previous line. The full structured regimen — including the specific procedures and their sequencing — is available through the link below.
More than 50% relief of occipital pain.
DOI: 10.1055/s-0040-1716451
The RFA induces permanent lesioning in the nerves and is therefore irreversible compared with PRF, owing to the application of RF thermal energy for prolonged time duration.
The authors followed the RF parameters as: 80°C for 180 seconds.
The parameters for RFA used were 80°centigrade for 90 seconds.
Gille and collegues performed the sectioning of the inferior oblique muscle along with neurolysis of the GON routinely and achieved excellent results in 7 out of ten patients.
Both Partial and Complete cervical dorsal rhizotomies (CDR) have been tried in refractory cases of ON.
Peripheral neurectomy of the GON, LON, and even the TON is a simple procedure that can be performed under local anesthesia.
More than 50% pain relief was noted in 80–90% patient population with ON undergoing neurolysis.
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