An Unusual Location for Sphenopalatine Ganglion in the Pterygopalatine Fossa Which May Facilitate Radiofrequency Neurolysis: A Case Report

Abstract

In this paper we demonstrated an unusual location for sphenopalatine ganglion (SPG) in the pterygopalatine fossa in a 33-year-old woman with intractable atypical trigeminal autonomic cephalalgia, who was a candidate for radiofrequency (RF) thermocoagulation of SPG. The classic radiographic target point is deeply situated in the uppermost part of the sphenopalatine (SP) fossa. This point can be classically addressed in the superomedial angle of the maxillary sinus, adjacent to the lateral wall of the nasal cavity in the AP view of C-Arm fluoroscopy images. In this patient placing the needle deeply in the SP fossa was not possible. However, sensory stimulation of SPG was associated with a satisfactory response and subsequent RF denervation led to adequate pain reduction. This report demonstrated that in difficult technical situations, when advancing the needle deeply in the SP fossa is not easily possible; adequate outcome of the sensory stimulation of the area, may justify accomplishing the procedure. This technique used in a more superficial location in SP fossa will reduce frequent attempts of needle manipulation, hematoma formation, vascular and neural injury, X-Ray exposure and eventually intranasal placement of the needle.

Verification of Sphenopalatine Ganglion Block Success Using Transcranial Doppler in Management of Patients with Postdural

“…Pain reduction may also be due to sensory stimulation of the ganglion, if the ganglion is at an unusual or inaccessible location. The latter assumption was supported by Majedi et al (25) who documented their observations in a case report of a 33-year-old patient with chronic headaches. This patient was prepared for radiofrequency (RF) denervation of the SPG.…”

“…This patient was prepared for radiofrequency (RF) denervation of the SPG. Majedi et al (25) faced a technical problem while they advanced the RF needle in the SP fossa, as the ganglion was found at an unusual location. However, this patient showed a satisfactory response after transnasal injection of a local anesthetic.…”

The Efficacy of Sphenopalatine Ganglion Block and Radiofrequency Denervation in the Treatment of Cluster Headache: A Case Series

“…Side effects of this procedure are mostly temporary and include infections, epistaxis, hematoma formation, anesthesia, or hypoesthesia in the palate and pharynx (5). Using real-time fluoroscopy has decreased the incidence of these complications (5,7). In this study, a total of 30 interventions, including prognostic block and neurolysis were done, of which only two had side effects.…”

“…the standard treatments for this headache in the pain literature; however, few studies have evaluated the extent and duration of the efficacy of this intervention (5,7,8).…”

Mastication Muscle Suppression by the Mandibular Branch of Trigeminal Nerve Catheter-Based, Ultrasound-Guided Block: A Case Report

“…TG has been blindly blocked through foramen ovale and in order to reduce the complications and to increase the accuracy of the block, the fluoroscopy-guided techniques were employed. Mandibular nerve, the third branch of the TG, can be selectively blocked by fluoroscopy or ultrasound guidance as well (5)(6)(7). Ultrasound guidance provides excellent visualization of these bony and soft tissue structures.…”