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. 2017 Dec 28;18(1):118.
doi: 10.1186/s10194-017-0826-y.

Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review

Kwo Wei David Ho  1 , Rene Przkora  2 , Sanjeev Kumar  2
Affiliations

Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review

Kwo Wei David Ho et al. J Headache Pain. .

Abstract

Background: Sphenopalatine ganglion is the largest collection of neurons in the calvarium outside of 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. Block, radiofrequency ablation, and neurostimulation have all been applied to treat a myriad of painful syndromes. Despite the routine use of these interventions, the literature supporting their use has not been systematically summarized. This systematic review aims to collect and summarize the level of evidence supporting the use of sphenopalatine ganglion block, radiofrequency ablation and neurostimulation.

Methods: Medline, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were reviewed for studies on sphenopalatine ganglion block, radiofrequency ablation and neurostimulation. Studies included in this review were compiled and analyzed for their treated medical conditions, study design, outcomes and procedural details. Studies were graded using Oxford Center for Evidence-Based Medicine for level of evidence. Based on the level of evidence, grades of recommendations are provided for each intervention and its associated medical conditions.

Results: Eighty-three publications were included in this review, of which 60 were studies on sphenopalatine ganglion block, 15 were on radiofrequency ablation, and 8 were on neurostimulation. Of all the studies, 23 have evidence level above case series. Of the 23 studies, 19 were on sphenopalatine ganglion block, 1 study on radiofrequency ablation, and 3 studies on neurostimulation. The rest of the available literature was case reports and case series. The strongest evidence lies in using sphenopalatine ganglion block, radiofrequency ablation and neurostimulation for cluster headache. Sphenopalatine ganglion block also has evidence in treating trigeminal neuralgia, migraines, reducing the needs of analgesics after endoscopic sinus surgery and reducing pain associated with nasal packing removal after nasal operations.

Conclusions: Overall, sphenopalatine ganglion is a promising target for treating cluster headache using blocks, radiofrequency ablation and neurostimulation. Sphenopalatine ganglion block also has some evidence supporting its use in a few other conditions. However, most of the controlled studies were small and without replications. Further controlled studies are warranted to replicate and expand on these previous findings.

Keywords: Block; Nerve stimulation; Neuromodulation; Neurostimulation; Radiofrequency ablation; Sphenopalatine ganglion.

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Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Overview of the systematic review process
Fig. 2
Fig. 2
Risk of bias summary of randomized-controlled studies
See this image and copyright information in PMC

References

    1. Piagkou M, Demesticha T, Troupis T, Vlasis K, Skandalakis P, Makri A, Mazarakis A, Lappas D, Piagkos G, Johnson EO. The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice. Pain Pract. 2012;12(5):399–412. doi: 10.1111/j.1533-2500.2011.00507.x. - DOI - PubMed
    1. Oluigbo CO, Makonnen G, Narouze S, Rezai AR. Sphenopalatine ganglion interventions: technical aspects and application. Prog Neurol Surg. 2011;24:171–179. - PubMed
    1. Scudds RA, Janzen V, Delaney G, Heck C, McCain GA, Russell AL, Teasell RW, Varkey G, Woodbury MG. The use of topical 4% lidocaine in spheno-palatine ganglion blocks for the treatment of chronic muscle pain syndromes: a randomized, controlled trial. Pain. 1995;62(1):69–77. doi: 10.1016/0304-3959(94)00232-4. - DOI - PubMed
    1. Kent S, Mehaffey G. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED. Am J Emerg Med. 2015;33(11):1714.e1711–1714.e1712. doi: 10.1016/j.ajem.2015.03.024. - DOI - PubMed
    1. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Group CBM. Group CSM The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. doi: 10.1136/bmj.d5928. - DOI - PMC - PubMed

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