Abstract：
Craniofacial pain syndromes exhibit a high prevalence in the general population, with a subset of patients developing chronic pain that significantly impacts their quality of life and results in substantial disabilities. Anatomical and functional assessments of the greater occipital nerve (GON) have unveiled its implication in numerous craniofacial pain syndromes, notably through the trigeminal-cervical convergence complex. The pathophysiological involvement of the greater occipital nerve in craniofacial pain syndromes, coupled with its accessibility, designates it as the primary target for various interventional procedures in managing craniofacial pain syndromes. This educational review aims to describe multiple craniofacial pain syndromes, elucidate the role of GON in their pathophysiology, detail the relevant anatomy of the greater occipital nerve (including specific intervention sites), highlight the role of imaging in diagnosing craniofacial pain syndromes, and discuss various interventional procedures such as nerve infiltration, ablation, neuromodulation techniques, and surgeries. Imaging is essential in managing these patients, whether for diagnostic or therapeutic purposes. The utilization of image guidance has demonstrated an enhancement in reproducibility, as well as technical and clinical outcomes of interventional procedures. Studies have shown that interventional management of craniofacial pain is effective in treating occipital neuralgia, cervicogenic headaches, cluster headaches, trigeminal neuralgia, and chronic migraines, with a reported efficacy of 60-90% over a duration of 1-9 months. Repeated infiltrations, neuromodulation, or ablation may prove effective in selected cases. Therefore, reassessment of treatment response and efficacy during follow-up is imperative to guide further management and explore alternative treatment options. Optimal utilization of imaging, interventional techniques, and a multidisciplinary team, including radiologists, will ensure maximum benefit for these patients.
摘要：
颅面疼痛综合征在普通人群中患病率很高，一部分患者出现慢性疼痛，严重影响他们的生活质量，并导致严重残疾。枕大神经（GON）的解剖和功能评估揭示了其在许多颅面疼痛综合征中的意义，特别是通过三叉神经-宫颈会聚复合体。枕大神经在颅面疼痛综合征中的病理生理参与，再加上它的可访问性，将其指定为治疗颅面疼痛综合征的各种介入程序的主要目标。这篇教育综述旨在描述多发性颅面疼痛综合征，阐明GON在其病理生理学中的作用，详细介绍枕大神经的相关解剖结构（包括特定的干预部位），强调影像学在诊断颅面疼痛综合征中的作用，并讨论各种介入程序，如神经浸润，消融,神经调节技术，和手术。影像学对这些患者的治疗至关重要，无论是诊断还是治疗目的。图像引导的利用证明了再现性的增强，以及介入手术的技术和临床结果。研究表明，颅面疼痛的介入治疗是治疗枕神经痛的有效方法，宫颈源性头痛,丛集性头痛，三叉神经痛,慢性偏头痛,在1-9个月的持续时间内，报告的疗效为60-90%。反复渗透,神经调节,或消融可能在选定的病例中有效。因此,必须在随访期间重新评估治疗反应和疗效,以指导进一步的治疗和探索替代治疗方案.成像的最佳利用，介入技术,和一个多学科的团队，包括放射科医生,将确保这些患者的最大利益。
