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

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✓ 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.

Article Information

Address reprint requests to: Michael Sanders, M.D., Department of Anesthesiology, Spaarne Hospital, Postbox 1644, 2003 BR Haarlem, The Netherlands.

© AANS, except where prohibited by US copyright law.

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Figures

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    Diagnostic criteria for episodic and chronic CH

  • View in gallery

    Schematic drawing showing anatomical landmarks with a dotted line drawn on the skin over the pterygopalatine fissure. 1 = pterygopalatine fissure; 2 = sphenopalatine ganglion; 3 = maxillary nerve; 4 = zygomatic arch; 5 = mandible; N = needle.

  • View in gallery

    Left: Lateral fluoroscopic view of the skull showing placement of the electrode through the pterygopalatine fissure into the sphenopalatine foramen. Right: Anteroposterior fluoroscopic view of the skull showing the correct placement of the electrode.

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