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Introduction: The knowledge of the anatomy of greater occipital nerve and its relation to occipital artery is important for the surgeon. Blockage or surgical release of greater occipital nerve is clinically effective in reducing or eliminating chronic migraine symptoms. Aim: The aim of this research was to study the anatomy of greater occipital nerve (GON) and its relation to occipital artery. Also the use of these anatomical measures in local injection of the greater occipital nerve for treatment of migraine. Materials and methods: The study was carried out at the Faculty of Medicine, Alexandria University. The posterior neck and scalp of 25 cadaveric heads were dissected. GON was identified and measured relative to bony landmarks. Delineation of GON and occipital artery relationship was done. Twenty patients suffering from migraine diagnosed according to International Headache Society (IHS) criteria (HIS 2004) were treated using GON blockade. The landmark for GON injection was based on the anatomical study. Treatment was assessed using the visual analogue scale for migraine pain. Results: In the anatomical study, the GON was found in all specimens. The diameter of GON was measured at the lower border of inferior oblique, where it pierced SSC, and after its exit from trapezius muscle. The distance between the point where the GON pierced SSC inferior to the external occipital protuberance (EOP) and lateral to the midline was also measured. The GON was parallel to the occipital artery. The distance between GON and occipital artery was measured. In the clinical study, 20 patients suffering from migraine were treated with 1.5 ml of 0.5% bupivacaine using GON blockade. The landmark for GON injection was based on the anatomical study. For the right GON: the vertical location inferior to EOP ranged from 19.85 mm to 26.9 mm with a mean of 23.1 mm. The lateral location from EOP ranged from 11.03 mm to 14.65 mm with a mean of 13.4 mm. For the left GON: the vertical location inferior to EOP ranged from 16.89 mm to 29.5 mm with a mean of 22.1 mm. The lateral location from EOP ranged from 10.89 mm to 15.31 mm with a mean of 14.1 mm.

Background Ultrasound-guided lumbar pain interventions were thought to be difficult; the high acoustic impedance of bone hides the underling structures and needle path. Reviewing the sonoanatomy of the lumbar region using different planes and angles made better sonographic guidance for spine injections. The aim of this prospective study is to assess the accuracy and safety of ultrasound (US)-guided lumbar trans-foraminal pulsed radiofrequency of the dorsal root ganglion confirmed by fluoroscopic imaging in management of chronic radicular pain. Results Thirty-two patients, with 34 lumbar interventions, were included in the study. Thirty-one interventions out of 34 were performed successfully with overall accuracy of 91.18% and with minimal complications. The successful first trial placement of the cannula was calculated in 44.1% of interventions; multiple trials were needed in 47.1% while incorrect level was encountered in 8.8%. Visual analogue scale of pain and Oswestry Disability Index decreased significantly after intervention up to 3 months compared to the pre-intervention value. The analgesic consumption was reduced by mean of 73.44 ± 31.07% 1 month after intervention. Conclusions US-guided fluoroscopic-verified trans-foraminal PR of lumbar DRG is accurate, safe, and effective for CRP.

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