Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: a 12- to 70-month follow-up evaluation

Abstract

This study was conducted to evaluate the efficacy, based on 12- to 70-month follow-up data, of radiofrequency (RF) lesions of the sphenopalatine ganglion made in patients suffering from cluster headache. Sixty-six patients suffering from either episodic (Group A, 56 patients) or chronic (Group B, 10 patients) cluster headache who were not responsive to pharmacological management were treated by RF lesioning in the sphenopalatine ganglion. Complete relief of pain was achieved in 34 (60.7%) of 56 patients in Group A and in three (30%) of 10 patients in Group B. No relief was found in eight patients (14.3%) in Group A and in four (40%) in Group B. The mean time of follow up was 29.1 +/- 10.6 months in Group A and 24 +/- 9.7 months in Group B, ranging from 12 to 70 months. With regard to side effects and complications, temporary postoperative epistaxis was observed in eight patients and a cheek hematoma in 11 patients; a partial RF lesion of the maxillary nerve was inadvertently made in four patients. Nine patients complained of hypesthesia of the palate, which disappeared in all cases within 3 months. The authors conclude that RF lesioning in the sphenopalatine ganglion via the infrazygomatic approach may be performed in patients suffering from cluster headache that does not respond to pharmacological therapy.

Surgical Interventions for Cluster Headache, Including Implanted Stimulators

“…An earlier study reported on complete pain relief in 3 out of 10 chronic cluster patients after radiofrequency lesioning of the sphenopalatine ganglion, but no relief was found in 4 patients with an average follow-up of 24 months (Sanders and Zuurmond 1997). Another study with 20 patients reported on good results, which were always temporarily (Felisati et al 2006).…”

“…Radiofrequency lesioning of the sphenopalatine ganglion can result in postoperative epistaxis, cheek hemorrhage, a lesion of the maxillary nerve and hypesthesia of the palate (Sanders and Zuurmond 1997;Narouze et al 2009). 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).…”

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

“…One advantage of iontophoresis appears to be the need for only 3 outpatient treatments, as compared to the average need for up to 13 intranasal injections as described by Puig et al [5] . Percutaneous radiofrequency lesioning has been more recently explored as a therapeutic option with some promising results [6] . Sanders et al [6] investigated sphenopalatine ganglion blockade by radiofrequency lesioning in patients suffering from cluster headaches (a clinical diagnosis believed by many to be pathophysiologically related to sphenopalatine neuralgia [1,7] ) whose pains were refractory to pharmacological as well as other surgical treatments.…”

“…Percutaneous radiofrequency lesioning has been more recently explored as a therapeutic option with some promising results [6] . Sanders et al [6] investigated sphenopalatine ganglion blockade by radiofrequency lesioning in patients suffering from cluster headaches (a clinical diagnosis believed by many to be pathophysiologically related to sphenopalatine neuralgia [1,7] ) whose pains were refractory to pharmacological as well as other surgical treatments. The results were encouraging in that 34 of 56 (61%) episodic cluster headache patients found complete pain relief.…”

Radiofrequency Ablation: A Nursing Perspective

“…Use of RFA also has been documented in the successful treatment of osteoid osteoma (Rosenthal, Hornicek, Torriani, Gebhardt, & Mankin, 2003;Woertler et al, 2001), painful bone metastases (Dupuy, Hong, Oliver, & Goldberg, 2000;Goetz et al, 2004), small renal cell tumors (< 3 cm) (Hwang et al, 2004), lung cancer (Gadaleta et al, 2004;Steinke, King, Glenn, & Morris, 2004a, 2004b, adrenals (Mayo-Smith & Dupuy, 2004;Melliza & Woodall, 2000;Wood, Abraham, Hvizda, Alexander, & Fojo, 2003) and painful soft tissue neoplasms (Locklin, Mannes, Berger, & Wood, 2004). RFA also has been used in nerve ganglia for treatment of pain syndromes such as trigeminal neuralgia (Onofrio, 1975;Oturai, Jensen, Eriksen, & Madsen, 1996), cluster headaches (Sanders & Zuurmond, 1997), chronic segmental thoracic pain (Stolker, Vervest, & Groen, 1994), cervicobrachialgia (Slappendel et al, 1997), and plantar fasciitis (Sollitto, Plotkin, Klein, & Mullin, 1997). Limited use of RFA in breast cancer (Jeffrey et al, 1999) has been documented.…”