First Case of Occipital Neuralgia Treated by Fascial Hydrodissection

Abstract

BACKGROUND The injection technique "hydrodissection" has been used to isolate the nerves from their surrounding structures, such as the fascia, to treat nerve entrapment. However, no study has reported the use of hydrodissection for the treatment of occipital neuralgia. This report presents the first case of occipital neuralgia treated by ultrasound-guided hydrodissection of the fascia. CASE REPORT An 81-year-old woman presented to the Emergency Department with severe, paroxysmal, stabbing pain headache lasting 4 days. Under a diagnosis of occipital neuralgia, we performed ultrasound-guided hydrodissection of the right semispinalis capitis, obliquus capitis inferior, and sternocleidomastoid muscles, wherein the trigger points were palpated using a low-dose anesthetic agent (9 mL saline and 1 mL 1% lidocaine). Her headache disappeared immediately after treatment. Subsequently, the headache would recur every few days; however, the pain intensity had decreased, and the patient could tolerate it. The same hydrodissection procedure was performed on days 2, 6, and 10 after the initial visit using 2000 mg acetaminophen and 120 mg loxoprofen per day, and the headache episodes disappeared. Treatment was discontinued 23 days after the initial visit; the patient was followed up for 4 weeks, and no headache recurrence was observed. CONCLUSIONS We found that fascial hydrodissection was an effective treatment option for occipital neuralgia attributed to myofascial pain syndrome. The risk of local anesthetic poisoning was very low. Fascial hydrodissection is recommended as a new treatment for occipital neuralgia. Treatment with hydrodissection may be applicable to other neuralgia types.

Figure 1.

Ultrasonographic images showing the position and hydrodissection process between the right semispinalis capitis and obliquus capitis inferior muscles. (A, B) During hydrodissection (out-of-plane technique). Arrow shows the location of the needle. The dotted line indicates the range of solutions injected. (1) C2 spinous process; (2) semispinalis capitis muscle; and (3) obliquus capitis inferior muscle.

Figure 2.

Timeline of treatment interventions and degree of headache.

Video 1.

Ultrasonographic movie showing hydrodissection process between the right semispinalis capitis and obliquus capitis inferior muscles.