Sphenopalatine ganglion radiofrequency ablation for management of atypical trigeminal neuralgia
Journal Title: Medpulse International Journal of Anesthesiology - Year 2018, Vol 8, Issue 3
Abstract
A 47 year old female patient came with left sided orofacial pain resistant to routine medications with aggravating factors which was treated initially with gasserian ganglion RFA. The procedure outcome did not relieved pain intensity significantly and was not even for a months. Measures directing towards sphenopalatine RFA showed promising pain relief i.e. VAS score reduction as 10/10 to 2/10. Patient tolerated the procedure well without any complications. Background: Sphenopalatine ganglion is the largest collection of neurons in the calvarium outside the brain. Over the past century, it has been a target for interventional treatment of head and facial pain due to its ease of access. The sensory input to the SPG is via branches from the maxillary nerve carrying sensations from the palate, buccal cavity, gingiva, and tonsils. Sphenopalatine ganglion (SPG) block has gained interest as an effective treatment modality for migraine and other headaches and facial pain syndromes. The diagnosis of trigeminal neuralgia (TN) critically depends on a patient’s description of pathognomonic pain attacks. Characterizations include notions of brief, sudden, stabbing, electric shock–like and severe pain attacks4. Etiologically established TN. This level of diagnostic certainty, based on identification of a cause for the TN, corresponds to 2 categories: classical and secondary TN is defined by an underlying cause. Both diagnostic entities qualify as definite neuropathic pain. Classical TN. Classical TN is defined as a specific category of TN in which MRI demonstrates vascular compression with morphologic changes of the trigeminal nerve root. Because of its sensitivity to detect pathologic processes involving brainstem and cranial nerves running through the base of the skull, MRI is widely seen as the method of choice to examine the trigeminal nerve and root. SPG blocks have been achieved with various techniques, including the use of lidocaine-soaked cotton tip applicator through the nose, trans orally, trans nasal endoscopic, infratemporal approach, and more recently using various non-invasive trans nasal devices to inject anesthetics into the SPG. Block, radiofrequency ablation, and neurostimulation have all been applied to treat a myriad of painful syndromes. In this case report, we demonstrate the effectiveness of the radiofrequency ablation technique for sphenopalatine ganglion block for the management of pain and we propose an increased consideration of the radiofrequency ablation for sphenopalatine ganglion block in treating atypical trigeminal neuralgia. Conclusion: Sphenopalatine ganglion RFA showed long term pain relief compared to other modalities.
Authors and Affiliations
Manoj Vitthal Shinde, Hemant Shivajirao Kshirsagar, Nana Dada Morkane, Leena Rahul Salunkhe
Keywords
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