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Imaging the Postoperative Scalp

4

and Cranium

Daniel Thomas Ginat, Ann-Christine Duhaime,

and Marc Daniel Moisi

4.1\ Occipital Nerve Stimulator

4.1.1\ Discussion

Occipital neuralgia that does not respond to conservative management is sometimes responsive to occipital nerve stimulation. Unilateral or bilateral electrodes are implanted in the posterior scalp subcutaneous tissues in contact with the occipital nerves. The device is connected to a

generator that is typically located subcutaneously in the chest. The main complications of this technique include electrode dislodgment and infection. Radiographs can depict the course of the leads, which is a nearly horizontal orientation in the occipital subcutaneous tissues, perpendicular to the course of the greater occipital nerves (Fig. 4.1). CT or MRI can be used to evaluate the extent of clinically suspected infection and other soft tissue complications.

D.T. Ginat, M.D., M.S. (*)

Department of Radiology,

University of Chicago, Chicago, IL, USA e-mail: dtg1@uchicago.edu

A.-C. Duhaime, M.D. Harvard Medical School,

Massachusetts General Hospital, Boston, MA, USA

M.D. Moisi, M.D., M.S.

Swedish Neuroscience Institute, Seattle, WA, USA

© Springer International Publishing Switzerland 2017

117

D.T. Ginat, P.-L.A. Westesson (eds.), Atlas of Postsurgical Neuroradiology,

DOI 10.1007/978-3-319-52341-5_4

118

D.T. Ginat et al.

 

 

a

b

Fig. 4.1  Occipital nerve stimulator. The patient has a history of intractable migraine headaches. Frontal (a) and lateral (b) radiographs of the skull show the electrodes situated in the bilateral occipital subcutaneous tissues (arrows)