European Radiology

, Volume 28, Issue 2, pp 886–893 | Cite as

Greater occipital nerve infiltration under MR guidance: Feasibility study and preliminary results

  • Adrian KastlerEmail author
  • Romain Perolat
  • Bruno Kastler
  • Caroline Maindet-Dominici
  • Jan Fritz
  • Alim Louis Benabid
  • Stephan Chabardes
  • Alexandre Krainik



To assess the feasibility of greater occipital nerve (GON) intermediate site infiltration with MRI guidance.


Eleven consecutive patients suffering from chronic refractory cranio-facial pain who underwent 16 GON infiltrations were included in this prospective study. All of the procedures were performed on an outpatient basis in the research facility of our institution, with a 1.5 T scanner. The fatty space between inferior obliquus and semispinalis muscles at C1-C2 level was defined as the target. Technical success was defined as the ability to accurately inject the products at the target, assessed by post-procedure axial and sagittal proton density-weighted sequences. Clinical success was defined as a 50% pain decrease at 1 month.


Technical success was 100%. GON was depicted in 6/11 cases on planning MRI sequences. Mean duration of procedure was 22.5 min (range 16–41). Clinical success was obtained in 7/11 included patients (63.6%) with a mean self-reported improvement of 78%.


Interventional MR-guidance for GON infiltration is a feasible technique offering similar results to an already established effective procedure. It may appear as a useful tool in specific populations, such as young patients and repeat infiltrations, and should be considered in these settings.

Key Points

MR guidance for GON infiltration is a feasible technique.

Preliminary results are in agreement with other guidance modalities.

MR guidance may be seen as a useful tool in specific populations.

Specific populations include young patients and repeat infiltrations.

Target patients may also include patients with potentionally previously reported complications (torticollis).


MR guidance Greater occipital nerve Neuralgia MRI Headache 



Computed tomography


Greater occipital nerve


Magnetic resonance imaging


Proton density


Pain Disability Index


Spectral Attenuated Inversion Recovery


Turbo Spin Echo




Visual Analogue Scale



The authors would like to sincerely thank Lilia Langar and Vincent Auboiroux for their help with MR acquisition and sequence development.

Compliance with ethical standards


The scientific guarantor of this publication is Alexandre Krainik.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.


Jan Fritz received institutional research funds and speaker’s honorarium from Siemens AG and is a scientific advisor of Siemens AG and Alexion Pharmaceuticals, Inc.


The authors state that this work has not received any funding.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• observational

• performed at one institution


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Copyright information

© European Society of Radiology 2017
corrected publication September 2017

Authors and Affiliations

  1. 1.Neuroradiology and MRI UnitGrenoble Alpes University HospitalGrenoble Cedex 9France
  2. 2.CLINATEC Research Facility, LETI, CEA GrenobleGrenobleFrance
  3. 3.Adult Radiology Department, Necker HospitalParis V UniversityParisFrance
  4. 4.Pain Management UnitGrenoble Alpes University HospitalGrenobleFrance
  5. 5.Russell H. Morgan Department of Radiology and Radiological ScienceThe Johns Hopkins University School of MedicineBaltimoreUSA
  6. 6.Neurosurgery UnitGrenoble Alpes University HospitalGrenobleFrance

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