Occipital Nerve Stimulation for Intractable Occipital Neuralgia
Bibliographic record
Abstract
INTRODUCTION: Occipital neuralgia (ON) is defined as paroxysmal jabbing pain in the cutaneous distribution of the greater or lesser occipital. Intermittent at first, it can become chronic and disabling. Electrical stimulation of the occipital nerve in refractory ON has been reported with initial good pain relief but without long lasting effects. Currently, electrodes are placed percutaneously under fluoroscopy. However, apposition of the electrode to the occipital nerve trunk cannot be confirmed. Furthermore, percutaneous electrodes are prone to migration, with subsequent loss of stimulation requiring surgical revision. We have developed a novel open surgical approach to position the electrode under direct visualization on the main nerve trunk. This surgical approach ensures proper electrode position in the long run. METHODS: Seven patients fulfilling the diagnostic criteria of ON were selected. The patients were assessed pre- and postoperatively using the visual analog scale and medication consumption. The open surgical technique was used to place the stimulator electrode. The operation consisted in skeletonizing the greater occipital nerve and placing the lead directly over the nerve. The electrode position was secured to the nerve using a pericardium sling. RESULTS: The preoperative visual analog scale (VAS) was 100 in three patients and 72, 76, 80, and 90 mm in the others. The postoperative VAS was 0 in all patients except one at 25 mm; this represents an overall 96% reduction in pain. Medications were stopped in five patients. Level of functioning was returned to premorbid level in all patients. One patient sustained a wound dehiscence, none had a lead migration. CONCLUSION: This open technique is superior to the percutaneous procedure because it ensures visual identification of the main trunk of the occipital nerve and optimal positioning of the stimulating electrode resulting in excellent long term pain control.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".