title: Value of intra- and post-operative cone beam computed tomography (CBCT) for positioning control of a sphenopalatine ganglion neurostimulator in patients with chronic cluster headache.
abstract: BACKGROUND
  The objective of this study was to determine whether postoperative control of the neurostimulator placement within the pterygopalatine fossa (PPF) by means of 3-dimensional (3D) cone beam computed tomography (CBCT) was of therapeutic relevance compared to intraoperative CBCT imaging alone.
  
  
  METHODS
  Immediately after implantation of the sphenopalatine ganglion (SPG) neurostimulator, intraoperative CBCT datasets were generated in order to visualize the position of the probe within the PPF. Postoperatively, all patients received a CBCT for comparison with intraoperatively acquired radiographs.
  
  
  RESULTS
  Twenty-four patients with cluster headache (CH) received an SPG neurostimulator. In 4 patients, postoperative CBCT images detected misplacement not found in intraoperative CBCT. In 3 cases, electrode tips were misplaced into the maxillary sinus and in 1 case into the apex of the PPF superior to the suspected location of the SPG. Immediate revision with successful repositioning within 3 days was done in 2 patients and a deferred reimplantation in 1 patient within 6 months. One patient declined revision.
  
  
  CONCLUSIONS
  We were able to demonstrate the clinical value of postoperative dental CBCT imaging with a wide region of interest (ROI) due to a superior image quality compared with that achieved with intraoperative medical CBCT. Although intraoperative 3D CBCT imaging of electrode placement is helpful in the acute surgical setting, resolution is, at present, too low to safely exclude misplacement, especially in the maxillary sinus. High-resolution postoperative dental CBCT allows rapid detection and revision of electrode misplacement, thereby avoiding readmission and recurrent tissue trauma.
authors: Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: a.assaf@uke.uni-hamburg.de.
authors: Alexandre T
authors: AT
authors: Assaf
authors: Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors: Jan C
authors: JC
authors: Klatt
authors: Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors: Marco
authors: M
authors: Blessmann
authors: Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors: Carsten
authors: C
authors: Kohlmeier
authors: Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors: Reinhard E
authors: RE
authors: Friedrich
authors: Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors: Philipp
authors: P
authors: Pohlenz
authors: Department of Systems Neuroscience, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors: Arne
authors: A
authors: May
authors: Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors: Max
authors: M
authors: Heiland
authors: Department of Systems Neuroscience, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors: Tim P
authors: TP
authors: Jürgens
mesh_terms: D000328:Adult; D000368:Aged; D003027:Cluster Headache / Q000628:therapy*; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000295:instrumentation*; D004567:Electrodes, Implanted / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging; D005726:Ganglia, Parasympathetic / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007430:Intraoperative Care; D008297:Male; D008443:Maxillary Sinus / Q000000981:diagnostic imaging; D008875:Middle Aged; D011182:Postoperative Care; D056739:Pterygopalatine Fossa / Q000000981:diagnostic imaging / Q000294:innervation*; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult
keywords: Cluster headache; Cone beam computed tomography; Pterygopalatine fossa; SPG Neurostimulator; Sphenopalatine ganglion