Merged Imaging and Expanded Target Selection in Gamma Knife Radiosurgical Ablation of the Sphenopalatine Ganglion

Abstract

Sphenopalatine neuralgia, or Sluder’s neuralgia, refers to a consistent clustering of clinical symptoms: intermittent episodes of vasomotor hyperactivity causing conjuctival injection, lacrimation, serous nasal discharge and unilateral nasal mucosal inflammation, sensory disturbances of the palate and oropharynx with distorted gustatory sensations, and lancing, unilateral pain most often located in the area of the inferomedial orbit and nasal base or at the region of the mastoid process. This particular clinical entity has also proven difficult to manage effectively, especially when not clearly secondary to other medical conditions such as paranasal sinus infection or bony nasal deformities. This condition has been treated with success using Gamma Knife radiosurgery in at least 1 other case reported in the literature. We present a second patient whose sphenopalatine neuralgia was treated successfully with stereotactic radiosurgery and discuss the possibilities of this modality as an option for patients with a refractory condition.

Evaluation of sphenopalatine ganglion blockade via intra oral route for the management of atypical trigeminal neuralgia

“…As the SPG has an important role on different pain syndromes, SPG blockade has an important role on the management of TN type 2. Many attempts including the removal of SPG cells, known as sphenopalatine ganglioneurectomy or radiosurgical neuroablation techniques have been described in the literature with varying success rates (Cepero et al 1987 ; Karas et al 2008 ). Besides, minimal invasive techniques via transnasal or infrazygomatic approaches described for modulating the action of SPG with different success rates.…”

The Pterygopalatine Ganglion and its Role in Various Pain Syndromes: From Anatomy to Clinical Practice

“…Sphenopalatine ganglion neuralgia or Sluder’s neuralgia (SPGN) is a type of facial neuralgia, defined as a symptom complex consisting of neuralgic, motor, sensory, and gustatory manifestations 32 . SPGN could be a trigeminal autonomic cephalalgia (TAC), described as unilateral facial pain in the orbital region that sometimes spreads retro‐orbitally toward the zygoma and extends posteriorly to the mastoid and occiput 33 . SPGN refers to intermittent episodes of vasomotor hyperactivity causing conjunctival injection, lacrimation, serous nasal discharge and unilateral nasal mucosal inflammation, and sensory disturbances of the palate and oropharynx with distorted gustatory sensations.…”