, Volume 56, Issue 7, pp 589–596 | Cite as

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

  • Adrian KastlerEmail author
  • Gilles Cadel
  • Alexandre Comte
  • Guillaume Gory
  • Veronique Piccand
  • Laurent Tavernier
  • Bruno Kastler
Head and Neck Radiology



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.


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.


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.


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.


Sphenopalatine ganglion Cranio-facial pain Alcohol Neurolysis CT guidance 


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.


  1. 1.
    Robert R, Lehur PA, Bordure T, Glemain P, Faure A, de Kersaint-Gilly A, Legent F (1991) Anatomical study of the infratemporal fossa. Ann Otolaryngol Chir Cervicofac 108(2):69–76PubMedGoogle Scholar
  2. 2.
    Kim HS, Kim DI, Chung IH (1996) High-resolution CT of the pterygopalatine fossa and its communications. Neuroradiology 38(Suppl 1):S120–S126PubMedCrossRefGoogle Scholar
  3. 3.
    Goadsby PJ, Edvinsson L (1994) Human in vivo evidence for trigeminovascular activation in cluster headache. Neuropeptide changes and effects of acute attacks therapies. Brain 117(Pt 3):427–434PubMedCrossRefGoogle Scholar
  4. 4.
    Goadsby PJ (2002) Pathophysiology of cluster headache: a trigeminal autonomic cephalgia. Lancet Neurol 1(4):251–257PubMedCrossRefGoogle Scholar
  5. 5.
    Schytz HW, Barlose M, Guo S, Selb J, Caparso A, Jensen R, Ashina M (2013) Experimental activation of the sphenopalatine ganglion provokes cluster-like attacks in humans. Cephalalgia 33(10):831–841PubMedCrossRefGoogle Scholar
  6. 6.
    Ruskin S (1925) Contributions to the study of the phenopalatine ganglion. Laryngoscope 35:87–108Google Scholar
  7. 7.
    Prasanna A, Murthy PS (1993) Sphenopalatine ganglion block and pain of cancer. J Pain Symptom Manage 8(3):125PubMedCrossRefGoogle Scholar
  8. 8.
    Cepero R, Miller RH, Bressler KL (1987) Long-term results of sphenopalatine ganglioneurectomy for facial pain. Am J Otolaryngol 8(3):171–174PubMedCrossRefGoogle Scholar
  9. 9.
    Ferrante FM, Kaufman AG, Dunbar SA, Cain CF, Cherukuri S (1998) Sphenopalatine ganglion block for the treatment of myofascial pain of the head, neck, and shoulders. Reg Anesth Pain Med 23(1):30–36PubMedGoogle Scholar
  10. 10.
    Procacci P, Francini F, Zoppi M, Maresca M (1975) Cutaneous pain threshold changes after sympathetic block in reflex dystrophies. Pain 1(2):167–175PubMedCrossRefGoogle Scholar
  11. 11.
    Tepper SJ, Stillman MJ (2013) Cluster headache: potential options for medically refractory patients (when all else fails). Headache 53(7):1183–1190PubMedCrossRefGoogle Scholar
  12. 12.
    Sanders M, Zuurmond WW (1997) Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: a 12- to 70-month follow-up evaluation. J Neurosurg 87(6):876–880PubMedCrossRefGoogle Scholar
  13. 13.
    Narouze S, Kapural L, Casanova J, Mekhail N (2009) Sphenopalatine ganglion radiofrequency ablation for the management of chronic cluster headache. Headache 49(4):571–577PubMedCrossRefGoogle Scholar
  14. 14.
    Ansarinia M, Rezai A, Tepper SJ, Steiner CP, Stump J, Stanton-Hicks M, Machado A, Narouze S (2010) Electrical stimulation of sphenopalatine ganglion for acute treatment of cluster headaches. Headache 50(7):1164–1174PubMedCrossRefGoogle Scholar
  15. 15.
    Kastler B (2007) Interventional radiology in pain treatment. Springer, BerlinCrossRefGoogle Scholar
  16. 16.
    Burstein R, Jakubowski M (2005) Unitary hypothesis for multiple triggers of the pain and strain of migraine. J Comp Neurol 493(1):9–14PubMedCrossRefGoogle Scholar
  17. 17.
    Sluder G (1908) The role of the sphenopalatine ganglion in nasal headache. NY State J Med 27:8–13Google Scholar
  18. 18.
    Ryan RE (1977) Symptomatic relief of migraine. Ear Nose Throat J 56(5):225–227PubMedGoogle Scholar
  19. 19.
    Windsor RE, Jahnke S (2004) Sphenopalatine ganglion blockade: a review and proposed modification of the transnasal technique. Pain Physician 7(2):283–286PubMedGoogle Scholar
  20. 20.
    Sluder G (1913) Etiology, diagnosis, prognosis, and treatment of sphenopalatine neuralgia. JAMA 61:1201–1216CrossRefGoogle Scholar
  21. 21.
    Yang LY, Oraee S (2006) A novel approach to transnasal sphenopalatine ganglion injection. Pain Physician 9(2):131–134PubMedGoogle Scholar
  22. 22.
    Felisati G, Arnone F, Lozza P, Leone M, Curone M, Bussone G (2006) Sphenopalatine endoscopic ganglion block: a revision of a traditional technique for cluster headache. Laryngoscope 116(8):1447–1450PubMedCrossRefGoogle Scholar
  23. 23.
    Meyer JS, Binns PM, Ericsson AD, Vulpe M (1970) Sphenopalatine gangionectomy for cluster headache. Arch Otolaryngol 92(5):475–484PubMedCrossRefGoogle Scholar
  24. 24.
    Jarrar RG, Black DF, Dodick DW, Davis DH (2003) Outcome of trigeminal nerve section in the treatment of chronic cluster headache. Neurology 60(8):1360–1362PubMedCrossRefGoogle Scholar
  25. 25.
    Green MW (2003) Long-term follow-up of chronic cluster headache treated surgically with trigeminal tractotomy. Headache 43(5):479–481PubMedCrossRefGoogle Scholar
  26. 26.
    Schoenen J, Jensen RH, Lanteri-Minet M, Lainez MJ, Gaul C, Goodman AM, Caparso A, May A (2013) Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study. Cephalalgia 33(10):816–830PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Leone M, Franzini A, Broggi G, Bussone G (2006) Hypothalamic stimulation for intractable cluster headache: long-term experience. Neurology 67(1):150–152PubMedCrossRefGoogle Scholar
  28. 28.
    Leone M, Franzini A, Bussone G (2001) Stereotactic stimulation of posterior hypothalamic gray matter in a patient with intractable cluster headache. N Engl J Med 345(19):1428–1429PubMedCrossRefGoogle Scholar
  29. 29.
    Leone M, Franzini A, Proietti Cecchini A, Bussone G (2013) Success, failure, and putative mechanisms in hypothalamic stimulation for drug-resistant chronic cluster headache. Pain 154(1):89–94PubMedCrossRefGoogle Scholar
  30. 30.
    Starr PA, Barbaro NM, Raskin NH, Ostrem JL (2007) Chronic stimulation of the posterior hypothalamic region for cluster headache: technique and 1-year results in four patients. J Neurosurg 106(6):999–1005PubMedCrossRefGoogle Scholar
  31. 31.
    Varghese B, Koshy R (2001) Endoscopic transnasal neurolytic sphenopalatine ganglion block for head and neck cancer pain. J Laryngol Otol 115(05):385–387PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Adrian Kastler
    • 1
    • 2
    Email author
  • Gilles Cadel
    • 2
  • Alexandre Comte
    • 3
  • Guillaume Gory
    • 2
  • Veronique Piccand
    • 4
  • Laurent Tavernier
    • 2
    • 5
  • Bruno Kastler
    • 2
    • 6
  1. 1.Neuroradiology DepartmentGrenoble University HospitalGrenobleFrance
  2. 2.I4S Laboratory, EA4268, IFR133Franche Comté UniversityBesançonFrance
  3. 3.Functional Imaging Research DepartmentUniversity Hospital BesançonBesançonFrance
  4. 4.Pain Evaluation and Treatment UnitUniversity Hospital Jean MinjozBesançonFrance
  5. 5.Head and Neck Surgery–Otolaryngology UnitUniversity Hospital Jean MinjozBesançonFrance
  6. 6.Interventional Pain Management UnitUniversity Hospital Jean MinjozBesançonFrance

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