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

  • Head and Neck Radiology
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Abstract

Introduction

The sphenopalatine ganglion (SPN) has been proven to be involved in various types of facial pain syndromes. Management of these cranio-facial pain syndromes can be challenging, and existing specific treatments are sometimes inefficient and may fail. The purpose of this study is to describe and evaluate alcohol SPN in the management of cranio-facial pain.

Methods

Forty-two patients suffering from refractory facial pain who underwent 58 consecutive SPN were included in this study between 2000 and 2013. Patients were divided into three groups: group “cluster headache” (CH), group “persistent idiopathic facial pain” (PFIP), and group “Other”. Pain was assessed using Visual Analogue Scale scores (measured immediately before and after procedure and at regular intervals following the procedure). Alcohol SPN was considered to be effective when pain relief was equal to or greater than 50 % and lasting for at least 1 month. All procedures were realized ambulatory under CT guidance and consisted of an injection of 1 ml of absolute alcohol.

Results

Overall efficacy rate of alcohol SPN was 67.2 %, with mean pain relief duration of 10.3 months. Procedure was graded either not painful or tolerable by patients in 64.2 %. Analysis showed a higher efficacy rate in the groups CH (76.5 %) and PFIP (85.7 %) compared to the group Other (40 %). No difference was found between groups regarding the recurrence rate.

Conclusion

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.

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Ethical standards and patient consent

We declare that all human and animal studies have been approved by the local institutional review board and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Neuroradiology Department, Grenoble University Hospital, Grenoble, France

    Adrian Kastler

  2. I4S Laboratory, EA4268, IFR133, Franche Comté University, Besançon, France

    Adrian Kastler, Gilles Cadel, Guillaume Gory, Laurent Tavernier & Bruno Kastler

  3. Functional Imaging Research Department, University Hospital Besançon, Besançon, France

    Alexandre Comte

  4. Pain Evaluation and Treatment Unit, University Hospital Jean Minjoz, Besançon, France

    Veronique Piccand

  5. Head and Neck Surgery–Otolaryngology Unit, University Hospital Jean Minjoz, Besançon, France

    Laurent Tavernier

  6. Interventional Pain Management Unit, University Hospital Jean Minjoz, Besançon, France

    Bruno Kastler

Authors
  1. Adrian Kastler
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  2. Gilles Cadel
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  3. Alexandre Comte
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  4. Guillaume Gory
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  7. Bruno Kastler
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Correspondence to Adrian Kastler.

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Kastler, A., Cadel, G., Comte, A. et al. Alcohol percutaneous neurolysis of the sphenopalatine ganglion in the management of refractory cranio-facial pain. Neuroradiology 56, 589–596 (2014). https://doi.org/10.1007/s00234-014-1354-y

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  • DOI: https://doi.org/10.1007/s00234-014-1354-y

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