Sphenopalatine Ganglionectomy for Cluster Headache

Meyer, John Stirling; Binns, P. M.; Ericsson, Arthur Dale; Vulpe, Michael

doi:10.1001/archotol.1970.04310050057009

Cited by 74 publications

(41 citation statements)

References 9 publications

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“…In the latter headache group, clinicians have long attempted to treat attacks and associated symptoms by targeting the sphenopalatine ganglion (SPG), a procedure first introduced at the beginning of the 20th century by Sluder to treat so-called Sluder's neuralgia, a type of trigeminal autonomic cephalalgia (9). Besides pharmacological blocks, SPG interventions have since included surgical or radiofrequency ablations, radiosurgical targeting or lesions (10)(11)(12)(13). As the SPG is the major source of parasympathetic innervation not only to the face but also to the cranial cavity, SPG activation could also be a likely contributor to migraine pathophysiology.…”

Section: Introductionmentioning

confidence: 99%

Sphenopalatine ganglion neuromodulation in migraine: What is the rationale?

2013

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Objective: The objective of this article is to review the prospect of treating migraine with sphenopalatine ganglion (SPG) neurostimulation. Background: Fuelled by preliminary studies showing a beneficial effect in cluster headache patients, the potential of treating migraine with neurostimulation has gained increasing interest within recent years, as current treatment strategies often fail to provide adequate relief from this debilitating headache.Common migraine symptoms include lacrimation, nasal congestion, and conjunctival injection, all parasympathetic manifestations. In addition, studies have suggested that parasympathetic activity may also contribute to the pain of migraineurs.The SPG is the largest extracranial parasympathetic ganglion of the head, innervating the meninges, lacrimal gland, nasal mucosa, and conjunctiva, all structures involved in migraine with cephalic autonomic symptoms. Conclusion: We propose two possible mechanisms of action: 1) interrupting the post-ganglionic parasympathetic outflow to inhibit the pain and cephalic autonomic symptoms, and 2) modulating the sensory processing in the trigeminal nucleus caudalis. To further explore SPG stimulation in migraineurs as regards therapeutic potential and mode of action, randomized clinical trials are warranted.

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Section: Introductionmentioning

confidence: 99%

Sphenopalatine ganglion neuromodulation in migraine: What is the rationale?

2013

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“…Surgical removal of the sphenopalatine ganglion has also been attempted, particularly in refractory cases [8] . In a study by Meyer et al [8] of 13 patients suffering from cluster headaches who also met criteria for sphenopalatine neuralgia and subsequently underwent sphenopalatine ganglionectomy, only 2 patients received complete relief for more than 1 year, while 4 obtained sufficient relief so that their pain could thereafter be controlled by analgesics.…”

Section: Discussionmentioning

confidence: 99%

“…In a study by Meyer et al [8] of 13 patients suffering from cluster headaches who also met criteria for sphenopalatine neuralgia and subsequently underwent sphenopalatine ganglionectomy, only 2 patients received complete relief for more than 1 year, while 4 obtained sufficient relief so that their pain could thereafter be controlled by analgesics. The remaining 7 cases experienced little relief from surgery, leading the authors to conclude that ganglionectomy should be held only for those with uncontrolled pain refractory to medical therapies.…”

Section: Discussionmentioning

confidence: 99%

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

Karas

Baig

Larson³

et al. 2008

Stereotact Funct Neurosurg

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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.

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“…Total destruction of the sphenopalatine ganglion could result in eye dryness (Meyer et al 1970), but the radiofrequency treatment now only aims at a partial lesion of the ganglion (van Kleef et al 2009). Pulsed radiofrequency is perhaps safer, but data on its efficacy in CH are lacking at present.…”

Section: Destructive Proceduresmentioning

confidence: 99%