Alcohol percutaneous neurolysis of the sphenopalatine ganglion in the management of refractory cranio-facial pain

Kastler, Adrian; Cadel, G.; Comte, Alexandre; Gory, Guillaume; Piccand, Véronique; Tavernier, L; Kastler, B.

doi:10.1007/s00234-014-1354-y

Cited by 25 publications

(15 citation statements)

References 26 publications

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“…One month later all patients still had decreased and more manageable pain. In a retrospective study by Kastler et al alcohol was used for SPG neurolysis in 42 patients with various refractory facial pain syndromes . The majority of the 58 procedures were performed utilizing infrazygomatic approach under CT guidance with the administration of 0.5 mL of lidocaine followed by 1 mL of absolute alcohol.…”

Section: Pathophysiologymentioning

confidence: 99%

The Sphenopalatine Ganglion: Anatomy, Pathophysiology, and Therapeutic Targeting in Headache

et al. 2015

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The sphenopalatine ganglion (SPG) has attracted the interest of practitioners treating head and face pain for over a century because of its anatomical connections and role in the trigemino-autonomic reflex. In this review, we discuss the anatomy of the SPG, as well as what is known about its role in the pathophysiology of headache disorders, including cluster headache and migraine. We then address various therapies that target the SPG, including intranasal medication delivery, new SPG blocking catheter devices, neurostimulation, chemical neurolysis, and ablation procedures.

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Section: Pathophysiologymentioning

confidence: 99%

The Sphenopalatine Ganglion: Anatomy, Pathophysiology, and Therapeutic Targeting in Headache

et al. 2015

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“…In recent years, there have been a series of reports on the treatment of CH via the pterygopalatine ganglion. One type of pterygopalatine ganglion treatment is destructive treatment, which blocks pain signalling by denaturing pterygopalatine ganglion proteins; treatments of this type include radiofrequency ablation techniques21 22 and local injection of absolute alcohol 23 24. The other type is minimally destructive treatment, such as NB,10 20 PRF16 and electrical nerve stimulation 13 25…”

Section: Discussionmentioning

confidence: 99%

“…Methods of pterygopalatine ganglion NB include cotton-swab nasal infiltration26 and needle injection 17 18. Puncture approaches to the pterygopalatine ganglion include the sphenopalatine foramen approach,27 the suprazygomatic approach,23 the infrazygomatic crest approach24 and the mandibular notch approach 28. Puncture can be performed with the assistance of nasal endoscopy,17 18 fluoroscopy21 22 or CT 9 16.…”

Section: Discussionmentioning

confidence: 99%

Multicentre, prospective, randomised, controlled, blinded-endpoint study to evaluate the efficacy and safety of pterygopalatine ganglion pulsed radiofrequency treatment for cluster headache: study protocol

Ren

Wang

et al. 2019

BMJ Open

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IntroductionSingle-centre reports on small groups of patients have shown that pterygopalatine ganglion pulsed radiofrequency treatment in patients with refractory cluster headache (CH) can quickly relieve pain without significant side effects. However, a randomised controlled trial is still necessary to evaluate whether pterygopalatine ganglion pulsed radiofrequency (PRF) treatment is a viable treatment option for patients with CH who are not responding to drug treatment.Methods and analysisThis investigation is a multicentre, prospective, randomised, controlled, blinded-endpoint study. We will enrol 80 patients with CH who are not responding to medication. The enrolled patients will be randomly divided into two groups: the nerve block (NB) group and the PRF group. All patients will undergo CT-guided pterygopalatine ganglion puncture. A mixture containing steroids and local anaesthetics will be slowly injected into the patients in the NB group. The patients in the PRF group will be treated with PRF at 42°C for 360 s. After treatment, the duration of cluster periods; degree of pain during headache attacks; frequency of headache attacks; duration of each headache attack; dose of auxiliary analgesic drugs; duration of remission; degree of patient satisfaction; effectiveness rates at 1 day, 3 days, 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year after the procedure; and intraoperative and postoperative adverse events will be compared between the two groups.Ethics and disseminationThis study was approved by the institutional ethics committee of the Beijing Tiantan Hospital (approval number: KY 2018-027-02). The results of the study will be published in peer-reviewed journals, and the findings will be presented at scientific meetings.Trial registration numberNCT03567590; Pre-results.

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“…Use of the infrazygomatic approach to reach the SPG has previously been performed using lateral fluoroscopy or CT‐guided injections . The disadvantage of these methods, however, is that fluoroscopy requires continuous X‐ray images and detailed anatomical knowledge of the area, while CT‐guided injection is limited by the number of repeated injections that can be performed (radiation), in addition to being more resource demanding and cumbersome.…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Outcome of Patients With Intractable Chronic Cluster Headache Treated With Injection of Onabotulinum Toxin A Toward the Sphenopalatine Ganglion – An Observational Study

2018

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ObjectivesTo investigate long‐term outcomes in per‐protocol chronic cluster headache patients (n = 7), 18 and 24 months after participation in “Pilot study of sphenopalatine injection of onabotulinumtoxinA for the treatment of intractable chronic cluster headache.”MethodsData were collected prospectively through headache diaries, HIT‐6, and open questionnaire forms at 18 and 24 months after the first treatment. Patients had access to repeated injections when needed.ResultsAn overall significant reduction in cluster headache attack frequency per month (57.3 ± 35.6 at baseline vs 12.4 ± 15.2 at month 18 and 24.6 ± 19.2 at month 24) was found. In addition, there was a reduction in attacks with severe and unbearably intensity (50.0 ± 38.3 at baseline vs 10.1 ± 14.7 at month 18 and 16.6 ± 13.7 at month 24) and an increase in attack free days (4.2 ± 5.9 at baseline vs 19.1 ± 9.4 at month 18 and 12.9 ± 8.8 at month 24).ConclusionsOur findings suggest sustained headache relief after repeated onabotulinumtoxinA injections toward the sphenopalatine ganglion in intractable chronic cluster headache. A placebo‐controlled trial with long‐term follow‐up is warranted.

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Alcohol percutaneous neurolysis of the sphenopalatine ganglion in the management of refractory cranio-facial pain

Abstract: Alcohol SPN under CT guidance appears as a safe and effective treatment of refractory facial pain, especially in cases of cluster headache and persistent idiopathic facial pain.

Cited by 25 publications

References 26 publications

The Sphenopalatine Ganglion: Anatomy, Pathophysiology, and Therapeutic Targeting in Headache

The Sphenopalatine Ganglion: Anatomy, Pathophysiology, and Therapeutic Targeting in Headache

Multicentre, prospective, randomised, controlled, blinded-endpoint study to evaluate the efficacy and safety of pterygopalatine ganglion pulsed radiofrequency treatment for cluster headache: study protocol

Long‐Term Outcome of Patients With Intractable Chronic Cluster Headache Treated With Injection of Onabotulinum Toxin A Toward the Sphenopalatine Ganglion – An Observational Study

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