It is with great interest that we read the article from Eichenberger et al.  1published in the February issue of Anesthesiology.

We congratulate the authors for providing another example of the clinical application of high-resolution sonography. However, the authors suggest that this is the only available technique for visualizing this nerve. This is not correct.

Magnetic resonance imaging is also capable of visualizing the third occipital nerve (fig. 1), and magnetic resonance imaging–guided blocks have been used to localize the source of headache pain.2,3 

Fig. 1. Transversal T1-weighted three-dimensional fast spin echo sequence with a repetition time of 500 ms, an echo time of 12 ms, an iPAT factor of 2, and a pixel size of 0.6 × 0.6 × 1.0 mm3. The three-dimensional slab contains 40 slices.  Arrows show the third occipital nerves on both sides. 
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Fig. 1. Transversal T1-weighted three-dimensional fast spin echo sequence with a repetition time of 500 ms, an echo time of 12 ms, an iPAT factor of 2, and a pixel size of 0.6 × 0.6 × 1.0 mm3. The three-dimensional slab contains 40 slices.  Arrows show the third occipital nerves on both sides. 

Fig. 1. Transversal T1-weighted three-dimensional fast spin echo sequence with a repetition time of 500 ms, an echo time of 12 ms, an iPAT factor of 2, and a pixel size of 0.6 × 0.6 × 1.0 mm3. The three-dimensional slab contains 40 slices.  Arrows show the third occipital nerves on both sides. 
View largeDownload slide

Fig. 1. Transversal T1-weighted three-dimensional fast spin echo sequence with a repetition time of 500 ms, an echo time of 12 ms, an iPAT factor of 2, and a pixel size of 0.6 × 0.6 × 1.0 mm3. The three-dimensional slab contains 40 slices.  Arrows show the third occipital nerves on both sides. 

Close modal

Our experience4–8with high-resolution sonography actually makes us believe in the claims by Eichenberger et al.  1But other methods may be equally useful, and additional studies are needed to validate this sonographic approach.

*Medical University of Innsbruck, Innsbruck, Austria. alois.obwegeser@uibk.ac.ator klaus.galiano@uibk.ac.at

1.
Eichenberger U, Greher M, Kapral S, Marhofer P, Wiest R, Remonda L, Bogduk N, Curatolo M: Sonographic visualization and ultrasound-guided block of the third occipital nerve: Prospective for a new method to diagnose C2–C3 zygapophysial joint pain. Anesthesiology 2006; 104:303–8
2.
Biondi DM: Cervicogenic headache: Diagnostic evaluation and treatment strategies. Curr Pain Headache Rep 2001; 5:361–8
3.
Biondi DM: Cervicogenic headache: A review of diagnostic and treatment strategies. J Am Osteopath Assoc 2005; 105:16S–22S
4.
Galiano K, Obwegeser AA, Bodner G, Freund M, Maurer H, Schatzer R, Fiegele T, Ploner F: Ultrasound-guided facet joint injections in the middle to lower cervical spine: A CT-controlled sonoanatomic study. Clin J Pain 2006; 22:538–43
5.
Galiano K, Obwegeser AA, Bodner G, Gruber H: Reply to Dr. Narouze. Reg Anesth Pain Med 2006; 31:87–8
6.
Galiano K, Obwegeser AA, Bodner G, Freund M, Maurer H, Kamelger FS, Schatzer R, Ploner F: Ultrasound guidance for facet joint injections in the lumbar spine: A computed tomography-controlled feasibility study. Anesth Analg 2005; 101:579–83
7.
Galiano K, Obwegeser AA, Bodner G, Freund MC, Gruber H, Maurer H, Schatzer R, Ploner F: Ultrasound-guided periradicular injections in the middle to lower cervical spine: An imaging study of a new approach. Reg Anesth Pain Med 2005; 30:391–6
8.
Galiano K, Obwegeser AA, Bodner G, Freund M, Maurer H, Kamelger FS, Schatzer R, Ploner F: Real-time sonographic imaging for periradicular injections in the lumbar spine: A sonographic anatomic study of a new technique. J Ultrasound Med 2005; 24:33–8