Background. Fluoroscopy-guided blockade of the greater occipital nerve (GON) is an accepted method for treating the symptoms of cervicogenic headaches (CGHs). However, the spread patterns among different injectate volumes of fluoroscopy-guided GON blocks are not well defined. Objective. A cadaveric study was established to determine the spread patterns of different volumes of dye injectate within a fluoroscopic GON block. Study Design. Cadaveric study. Setting. Xingtai Institute of Orthopaedics; Orthopaedic Hospital of Xingtai. Methods. 15 formalin-fixed cadavers with intact cervical spines were randomized in a 1 : 1 : 1 ratio to receive a fluoroscopy-guided GON injection of a 2, 3.5, or 5 ml volume of methylene blue. The suboccipital regions were dissected to investigate nerve involvement. Results. The suboccipital triangle regions, including the suboccipital nerves and GONs, were deeply stained in all cadavers. The third occipital nerve (TON) was stained in 7 of 10 administered 2 ml injections and in all the 3.5 ml and 5 ml injections. Compared to the 3 ml injectate group, the 5 mL cohort consistently saw injectate spreading to both superficial and distant muscles. Limitations. Given that cadavers were used in this study, cadaveric soft tissue composition and architecture can potentially become distorted and consequently affect injectate diffusion. Conclusions. A 3.5 or 5 mL fluoroscopy-guided GON injection of methylene blue successfully stains the GON, TON, and suboccipital nerves. This suggests that such an injection would generate blockade of all three nerve groups, which may contribute to the efficacy of the block for CGH. A volume of 3.5 ml may be enough for the performance of a fluoroscopy-guided GON block for therapeutic purposes.

中文翻译：

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荧光镜引导下的大枕叶神经阻滞：不同注射量的散布和神经侵犯的比较

背景。透视引导下枕大神经（GON）的阻滞是公认的治疗宫颈源性头痛（CGH）症状的方法。但是，荧光透视引导的GON块在不同注射体积之间的分布方式尚不明确。目标。建立了尸体研究来确定荧光透视GON块内不同体积染料注入的扩散模式。研究设计。尸体研究。设置。邢台骨科学所；邢台骨科医院。方法。将15个具有完整颈椎的福尔马林固定的尸体以1：1的比例随机分配，以接受X线透视引导下的GON注射，注入量为2、3.5或5 ml的亚甲蓝。解剖枕下下区域以调查神经受累情况。结果。在所有尸体中，包括枕下神经和GON在内的枕下三角区域都被深深染色。在注射2 ml注射液的10次中有7次以及在3.5 ml和5 ml注射液中均对第三枕神经（TON）染色。与3 ml注射组相比，5 ml队列始终看到注射扩散到浅层和远处的肌肉。局限性。鉴于本研究中使用了尸体，尸体的软组织组成和结构可能会变形，从而影响注射扩散。结论。3.5或5 mL荧光镜引导下的GON注射亚甲蓝可成功染色GON，TON和枕下神经。这表明这种注射会产生对所有三个神经组的阻断，这可能有助于阻断​​CGH的功效。3.5 ml的体积可能足以用于荧光透视引导的GON块的治疗目的。