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Unsuccessful Pulsed Radiofrequency of the Sphenopalatine Ganglion in Patients with Chronic Cluster Headache and Subsequent Successful Thermocoagulation
Author(s) -
Bendersky Damián Claudio,
Hem Santiago Matias,
Yampolsky Claudio Gustavo
Publication year - 2015
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12288
Subject(s) - medicine , pulsed radiofrequency , ganglion , cluster headache , anesthesia , lidocaine , surgery , local anesthetic , refractory (planetary science) , pain relief , physics , migraine , astrobiology , anatomy
We present the results of pulsed and continuous radiofrequency (CRF) of the sphenopalatine ganglion in a case series of 3 patients with chronic cluster headache ( CCH ). Three patients were referred to our neurosurgical department because of CCH , which was refractory to pharmacological treatment. They underwent pulsed radiofrequency of the sphenopalatine ganglion ( PRF ‐ SPG ), and the procedure was performed through an infrazygomatic approach. In the PRF procedures, we applied 2 cycles of PRF at 42°C and 45 V for 120 seconds, with a pulse frequency of 2 Hz and a pulse width of 20 ms. In those procedures where thermocoagulation was carried out, 2 CRF lesions at 80°C for 90 seconds each were performed. Following corticosteroid and local anesthetic (40 mg of methylprednisolone and 1 mL of 1% lidocaine) injection, 2 patients had no pain relief at all, whereas the third one experienced a partial response, which lasted only 1 month and his pain then returned to its baseline level. Thus, this outcome was assessed as a nonsustained partial response. Therefore, all of them underwent a CRF lesioning of the SPG , and after this procedure, they achieved complete pain relief until the end of the follow‐up period. Furthermore, the associated autonomic manifestations disappeared. The 3 patients presented in this case series failed to achieve adequate pain relief after PRF ‐ SPG . However, these same patients subsequently underwent a successful CRF of the SPG .