Presented at the 2012 AAPM Annual Meeting « Back

Sphenopalatine Ganglion Alcohol Neurolysis in the Management of Craniofacial Pain in 53 Procedures

Adrian Kastler, MD, tomasi@noos.fr¹, Sébastien Aubry, MD PhD², Gilles Cadel, Véronique Piccand, MD³, Florence Tiberghien, MD⁴, Bruno Kastler, MD PhD², (1) Clermont Ferrand, Auvergne, France, (2) Interventional Pain Management Unit, Besancon, Doubs, France, (3) Medecine, Besancon, Doubs, France, (4) CETD CHu jean Minjoz, Besancon, Doubs, France

Introduction: These last few years, a number of interventional, minimally invasive techniques have been used to manage sphenopalatine-involved pain. We propose an alternate to existing treatment of facial pain with alcohol neurolysis of the sphenopalatine (SPN) ganglion. Materials and Method: Thirty-eight patients were included in this retrospective study. A total of 53 SPN were performed using absolute alcohol. IRB approval was obtained. The SPN was considered to be effective when pain relief was equal to or greater than 50% lasting for at least one week. Mean pain relief period following procedure was noted. In case of recurring pain, duration and intensity of pain were noted. All procedures were performed ambulatory under local anesthesia and CT guidance. Results: Mean duration of facial pain before procedure was 6.1 years. Thirty-six out of the 53 performed SPN were successful. Overall mean duration of pain relief was 8.7 months after SPN. In 27% of the successful cases, no recurrence of pain occurred. In 26/36 successful SPN, recurring pain occurred with a mean duration of 5.4 months after initial procedure. Success rate of SPN depending on pain type are as follows: atypical facial pain: 85.7% (p<0.05); cluster headache: 83.3% (P<0.05); Trigeminal Neuralgia: 50% (p<0.05); compression by neoplasm: 100% (p<0.05). Complications encountered were as follows: Short term: four local hematomas seen on control slices (7.5%), four transient hemipalate anesthesia (7.5%), and three pain increase after procedure (5.7%); long term: two cases of persisting hemipalate paresthesia (3.8%), two cases of persisting hemipalate anesthesia (3.8%). No epistaxis or lachrymal dryness was noted. Conclusion: CT-guided alcohol SPN is a safe and effective treatment of refractory chronic craniofacial pain syndromes, especially in cases of cluster headaches, atypical facial pain, and trigeminal neuralgia.

Funding: None