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


CONCLUSIONS
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.
Neuroradiology Department, Grenoble University Hospital, Grenoble, France, adriankastler@gmail.com.
Adrian
A
Kastler
Gilles
G
Cadel
Alexandre
A
Comte
Guillaume
G
Gory
Veronique
V
Piccand
Laurent
L
Tavernier
Bruno
B
Kastler
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000000981:diagnostic imaging / Q000628:therapy*; D000431:Ethanol / Q000627:therapeutic use*; D005157:Facial Pain / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods*; D059387:Sphenopalatine Ganglion Block / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D000431:Ethanol