Sphenopalatine Ganglionectomy for Cluster Headache
01 Nov 1970-Archives of Otolaryngology-head & Neck Surgery (American Medical Association)-Vol. 92, Iss: 5, pp 475-484
TL;DR: Patients with severe cluster headaches who underwent surgery for removal of the sphenopalatine ganglion obtained little relief, but six-month follow-up of one patient revealed that he was experiencing minimal pain.
Abstract: Thirteen patients who experienced severe cluster headaches and who met the criteria of sphenopalatine neuralgia underwent surgery for removal of the sphenopalatine ganglion. Seven patients obtained little relief, but six-month follow-up of one patient revealed that he was experiencing minimal pain. Four obtained sufficient relief so that analgesics were effective in controlling recurring headaches. Two have had complete relief for more than one year. Centrally located discharges within the brain stem may be responsible for the episodic pain. Regeneration of afferent nerve fibers may account for delayed recurrence of the pain following sphenopalatine ganglionectomy. Medical treatment is recommended in the majority of patients with this type of headache. Ganglionectomy should be reserved only for patients with intractable and severe headaches that do not respond to medical therapy.
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17 Jun 2009
TL;DR: In this paper, a method for the suppression or prevention of pain, movement disorders, epilepsy, cerebrovascular diseases, autoimmune diseases, sleep disorders, autonomic disorders, urinary bladder disorders, abnormal metabolic states, disorders of the muscular system, and neuropsychiatric disorders in a patient.
Abstract: A method is provided for the suppression or prevention of pain, movement disorders, epilepsy, cerebrovascular diseases, autoimmune diseases, sleep disorders, autonomic disorders, urinary bladder disorders, abnormal metabolic states, disorders of the muscular system, and neuropsychiatric disorders in a patient. The method comprises positioning at least one electrode on or proximate to at least one of the patient's sphenopalatine ganglia (“SPG”), sphenopalatine nerves (“SPN”), or vidian nerves (“VN”), and activating the at least one electrode to apply an electrical signal to at least one of the SPG, SPN, or VN. In a further embodiment of the invention used to treat the same conditions, the electrode used is capable of dispensing a medication solution or analgesic which is applied via an electrode to at least one of the SPG, SPN, or VN. A method is also provided for surgically implanting an electrode on or proximate to at least one of the SPG, SPN, or VN of a patient.
216 citations
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TL;DR: It is concluded 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.
Abstract: ✓ 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 pati...
211 citations
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TL;DR: Percutaneous radiofrequency ablation of the sphenopalatine ganglion was shown before to improve episodic cluster headache but not chronic cluster headache, and this work was interested in examining the effect of such intervention in patients with intractable chronic cluster headaches who failed pharmacological management.
Abstract: Objectives.— Chronic cluster headache patients are often resistant to pharmacological management. Percutaneous radiofrequency ablation (RFA) of the sphenopalatine ganglion (SPG) was shown before to improve episodic cluster headache but not chronic cluster headache. We were interested to examine the effect of such intervention in patients with intractable chronic cluster headache who failed pharmacological management.
Methods.— Fifteen patients with chronic cluster headache, who experienced temporary pain relief following SPG block, underwent percutaneous RFA via the infrazygomatic approach under fluoroscopic guidance. Collected data include demographic variables, onset and duration of the headache, mean attack intensity (MAI), mean attack frequency (MAF), and pain disability index (PDI) before and up to 18 months after procedure.
Results.— At 1-, 3-, 6-, 12-, 18-month follow-up, the MAI was 2.6, 3.2, 3.2, 3.4, 4.2, respectively (P < .0001, P < .0001, P < .0001, P < .0005, P < .003, respectively). The PDI improved from 55 (baseline) to 17.2 and 25.6 at 6 and 12 months respectively (P < .001). The MAF improved from 17 attacks/week to 5.4, 6.4, 7.8, 8.6, 8.3 at 1-, 3-, 6-, 12-, 18-month follow-up visits (P < .0001, P < .0001, P < .0001, P < .002, P < .004, respectively).
Conclusion.— Our data showed that percutaneous RFA of the SPG is an effective modality of treatment for patients with intractable chronic cluster headaches. Precise needle placement with the use of real-time fluoroscopy and electrical stimulation prior to attempting radiofrequency lesioning may reduce the incidence of adverse events.
161 citations
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TL;DR: In this article, the sphenopalatine ganglion (SPG) was used for short-term (up to 1 hour) electrical stimulation of the SPG during an acute CH.
Abstract: (Headache 2010;50:1164-1174)
Introduction.— Cluster headaches (CH) are primary headaches marked by repeated short-lasting attacks of severe, unilateral head pain and associated autonomic symptoms. Despite aggressive management with medications, oxygen therapy, nerve blocks, as well as various lesioning and neurostimulation therapies, a number of patients are incapacitated and suffering. The sphenopalatine ganglion (SPG) has been implicated in the pathophysiology of CH and has been a target for blocks, lesioning, and other surgical approaches. For this reason, it was selected as a target for an acute neurostimulation study.
Methods.— Six patients with refractory chronic CH were treated with short-term (up to 1 hour) electrical stimulation of the SPG during an acute CH. Headaches were spontaneously present at the time of stimulation or were triggered with agents known to trigger clusters headache in each patient. A standard percutaneous infrazygomatic approach was used to place a needle at the ipsilateral SPG in the pterygopalatine fossa under fluoroscopic guidance. Electrical stimulation was performed using a temporary stimulating electrode. Stimulation was performed at various settings during maximal headache intensity.
Results.— Five patients had CH during the initial evaluation. Three returned 3 months later for a second evaluation. There were 18 acute and distinct CH attacks with clinically maximal visual analog scale (VAS) intensity of 8 (out of 10) and above. SPG stimulation resulted in complete resolution of the headache in 11 attacks, partial resolution (>50% VAS reduction) in 3, and minimal to no relief in 4 attacks. Associated autonomic features of CH were resolved in each responder. Pain relief was noted within several minutes of stimulation.
Conclusion.— Sphenopalatine ganglion stimulation can be effective in relieving acute severe CH pain and associated autonomic features. Chronic long-term outcome studies are needed to determine the utility of SPG stimulation for management and prevention of CH.
153 citations
Cites background from "Sphenopalatine Ganglionectomy for C..."
...Interventional procedures including SPG blocks and lesioning have also demonstrated relief of CH pain.(6-15) The growing scientific rationale, the anatomical location, and the development of a range of minimally invasive interventional approaches to the SPG make it a plausible target of exploration for neuromodulation approaches....
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TL;DR: In this paper, a hypothesis about the pathophysiology of cluster headache, against the background of recent morphological and functional evidence for substance P (SP) neurons in the ipsilateral trigeminal nerve and its connections to various cranial structures including the sphenopalatine (pterygopalataine) ganglion and internal carotid perivascular nerve plexus, was forwarded.
Abstract: SYNOPSIS
Substance P (SP) neurons, with bipolar axons from the cell body, in sensory ganglia, exhibit unique properties in that impulses may travel either orthodromically or antidromically in the various ramifications of the axons, and that the transmitter may be released both in the central and peripheral ends of the neuron. Thus, these nerves are not only sensory, carrying nociceptive impulses from the periphery, but also motor with ability to dilate blood vessels, constrict smooth muscle cells and cause protein extravasation, glandular secretion, release from mast cells and excitation of autonomic ganglion cells. Within the individual neuron several local reflex arches - axon reflexes - are established in this way.
An hypothesis is forwarded about the pathophysiology of cluster headache, against the background of recent morphological and functional evidence for SP neurons in the ipsilateral trigeminal nerve and its connections to various cranial structures including the sphenopalatine (pterygopalatine) ganglion and internal carotid perivascular nerve plexus. Activation of SP fibers in the ophthalmic and maxillary divisions may give rise to practically all symptoms of an attack of cluster headache. This provides a rational explanation for the beneficial effect on both pain and vegetative symptoms achieved by blockade of the Gasserian or sphenopalatine ganglia in this disease. A temporary arrest of central inhibitory serotonergic impulses presynaptically on the SP neurons in the caudal trigeminal nucleus is, with our present knowledge, a likely explanation for such an activation, even if it may not be the only factor. A comparison is made with the present opinion on activation of parasympathetic and blockade of sympathetic nerves to explain the various symptoms of a cluster attack.
124 citations
References
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TL;DR: This outline defines headaches somewhat broadly; it covers both painful and nonpainful discomforts of the entire head, including the face and upper nucha, which commonly denotes head pain from brow level up.
Abstract: THE TERM HEADACHE commonly denotes head pain from brow level up. This outline defines headaches somewhat broadly; it covers both painful and nonpainful discomforts of the entire head, including the face and upper nucha. Since so much that a man describes as headache may be any abnormal head sensation, it is essential for proper treatment to determine whether the complaint is actually one of pain. A useful scheme for the classification of the varieties of headache is one based on pain mechauisms. The divisions rest on experimental and clinical data, together with reasonable inference; the story is far from complete. Yet the arrangement can serve as a framework for diagnostic criteria for the major clinical types of headache and by emphasis on basic mechanisms it offers a logical approach to the planning of therapeutic trials. For convenience, short and simple names are suggested for certain major entities and are indicated in boldface type. Essential in the study of headache in most instances is an appraisal of its close link to the patient’s situation, activities, and attitudes. Sometimes in obvious ways, more often in subtle ones, headache may be the principal manifestation of temporary or sustained dif6culties in life adjustment. These relationships are notably evident in Croups I through V.
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TL;DR: A new syndrome of vascular headache is described, which MacLean, Craig and I shall call "histaminic cephalgia" hereafter, and the results of treatment with histamine are reported.
Abstract: Headache is undoubtedly among the most frequent ills to which the human flesh is heir. It is a complaint which has been known to mankind since the dawn of antiquity. Few contributions, however, have marked medical progress in this field. It is not my purpose to review or consider the differential diagnostic features of the various types of headaches and head pains which have been recorded in the literature but rather to describe a new syndrome of vascular headache and to report the results of treatment with histamine. Other less well defined types of headaches have also been treated with histamine and the results will be reported. This new syndrome of vascular headache, which MacLean, Craig and I1tentatively called "erythromelalgia of the head" and which I shall call "histaminic cephalgia" hereafter, was first encountered and recognized at the Mayo Clinic in September 1937. At that time the syndrome
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