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Temblador Barba I, Lozano Sánchez JJ, Rodríguez Suárez AH. Ocular involvement in sphenopalatin ganglion pulsed radiofrequency. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:544-547. [PMID: 37353073 DOI: 10.1016/j.oftale.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/26/2023] [Indexed: 06/25/2023]
Abstract
Pulsed radiofrequency (PRF) treatment of the sphenopalatine ganglion is an important interventional treatment in refractory cases of trigeminal neuralgia (TN) or atypical facial pain, given the easy access to its location. Despite the fact that complications from this technique are rare and it is a fairly safe procedure, ophthalmologists should know about it due to the anatomical relations of this ganglion.
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Affiliation(s)
- I Temblador Barba
- FEA Oftalmología, Coordinadora de la Unidad de Uveítis y Oculoplastia, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain.
| | - J J Lozano Sánchez
- FEA Anestesiología, Reanimación y Terapia del Dolor, Coordinador de la Unidad del Dolor, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain
| | - A H Rodríguez Suárez
- FEA Oftalmología, Coordinador de la Unidad de Uveítis y Oculoplastia, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain
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Zhu J, Luo G, He Q, Yao M. Evaluation of the efficacy of unipolar and bipolar spinal dorsal root ganglion radiofrequency thermocoagulation in the treatment of postherpetic neuralgia. Korean J Pain 2022; 35:114-123. [PMID: 34966018 PMCID: PMC8728553 DOI: 10.3344/kjp.2022.35.1.114] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/28/2021] [Accepted: 11/12/2021] [Indexed: 11/14/2022] Open
Abstract
Background Different views have been proposed on the radiofrequency treatment modes and parameters of radiofrequency thermocoagulation of the spinal dorsal root ganglion for the treatment of postherpetic neuralgia (PHN). It is urgent to identify a more effective therapy for patients with PHN. Methods Patients who underwent radiofrequency thermocoagulation therapy for PHN were retrospectively reviewed and were divided into a radiofrequency thermocoagulation (CRF) and double neddles radiofrequency thermocoagulation (DCRF). The pain scores (numerical rating scale, NRS) were evaluated at the following time points before the operation, 1 day, 3 months, 6 months, 1 year, and 2 years after operation. The incidence of complications and the degree of pain relief were evaluated. The in vitro ovalbumin experiment was used to indicate the effects of radiofrequency thermocoagulation. Results Compared with the preoperative NRS scores, the postoperative NRS scores decreased significantly; the NRS scores of the DCRF group was lower than that of the CRF group at all time points from 6 months to 2 years following the operation. The total effective rate of the DCRF group was significantly higher than that of the CRF group at 2 years following the operation. The incidence of numbness in the DCRF group was higher than that noted in the CRF group. The ovalbumin experiments in vitro indicated that the effects of radiofrequency thermocoagulation were optimal when the distance between the two needles was 5 mm. Conclusions DCRF with a 5 mm spacing exhibits a longer duration and higher effective rate in the treatment of PHN and is worth promoting.
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Affiliation(s)
- Jianjun Zhu
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Ge Luo
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Qiuli He
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Ming Yao
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, China
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Radiofrequency Ablation for Craniofacial Pain Syndromes. Phys Med Rehabil Clin N Am 2021; 32:601-645. [PMID: 34593133 DOI: 10.1016/j.pmr.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Headache disorders and trigeminal neuralgia are common conditions representing the types of craniofacial pain syndrome that can significantly impact quality of life. Many cases are refractory to traditional pharmacologic treatments, whether oral or intravenous. Radiofrequency ablation has been increasingly used as a tool to treat resistant, chronic pain of both of these disorders. Multiple studies have been reported that illustrate the efficacy of radiofrequency ablation in the treatment of the numerous headache subtypes and trigeminal neuralgia.
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Belgrado E, Surcinelli A, Gigli GL, Pellitteri G, Dalla Torre C, Valente M. A Case Report of Pulsed Radiofrequency Plus Suboccipital Injection of the Greater Occipital Nerve: An Easier Target for Treatment of Cluster Headache. Front Neurol 2021; 12:724746. [PMID: 34650507 PMCID: PMC8508784 DOI: 10.3389/fneur.2021.724746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In cluster headache, the efficacy of suboccipital steroid injection is notable within a few days, although few data are available about the duration of efficacy. A combination treatment, consisting of suboccipital steroid injection plus pulsed radiofrequency, could potentially lead to long-term benefit. Evidence about pulsed radiofrequency of the greater occipital nerve is lacking. Patients and Methods: We retrospectively describe a series of four cluster headache patients treated with suboccipital steroid injection plus pulsed radiofrequency of the greater occipital nerve. Results: All patients achieved a 50% reduction in attack frequency in the 7 days after the first treatment. Moreover, a long pain-free remission period up to 15 months was noted. Conclusion: Suboccipital steroid injection plus pulsed radiofrequency of the greater occipital nerve might have both acute and prophylactic effects in cluster headache. The greater occipital nerve is more accessible to pulsed radiofrequency than other targets.
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Affiliation(s)
- Enrico Belgrado
- Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
| | - Andrea Surcinelli
- Clinical Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Gaia Pellitteri
- Clinical Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Chiara Dalla Torre
- Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
- Department of Medical Area (DAME), University of Udine, Udine, Italy
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Abstract
PURPOSE OF REVIEW The treatment of cluster headache has evolved to include a handheld neuromodulation device and a monoclonal antibody in addition to more traditional agents. RECENT FINDINGS Galcanezumab is an approved treatment for episodic cluster headache. The non-invasive vagal nerve stimulator has been shown to be effective as a treatment for episodic cluster headache. Dedicated pituitary imaging may not be necessary with a normal MRI of the brain. Cluster headache is the most common trigeminal-autonomic cephalalgia, characterized by unilateral, frequent, debilitating attacks associated with ipsilateral autonomic symptoms. Attacks have a circadian and, often, seasonal pattern with periods of remission that can last months to years in episodic patients. Though a rare disease, an increasing number of studies have revealed novel targets for treatment. Treatment in cluster headache should focus on early intervention to reduce frequency of attacks and the length of the cycle, which improves outcomes and disability. Acute therapy is used to treat attacks, while bridging and preventive therapies are combined to reduce cycle length. Case 1: A 43-year-old man presents with the chief complaint of severe headaches. Upon general examination, he seems uncomfortable, agitated, and exhausted. He states that he hasn't "slept in over a week because of debilitating headaches." His headaches start around the same time every night: when he lays down to go to sleep. The pain is described as sharp, like a "hot poker" to his left eye. His partner has noticed that his eye droops and turns red when the pain starts. The attacks come on abruptly and prevent him from sleeping. The severe pain lasts 30 to 45 min, but he has mild-to-moderate pain that lingers for the rest of the night. He has seen his primary care physician, an allergist, and an ear, nose, and throat (ENT) specialist before coming to see a neurologist. Similar headaches occurred last year during the month of October as well. On further questioning, he reports that these headache attacks have been occurring almost yearly for the past 7 years. Each year, these headaches come on as the weather is changing and occur on a nightly basis for about 3 to 4 weeks.
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Interventional Radiofrequency Treatment for the Sympathetic Nervous System: A Review Article. Pain Ther 2021; 10:115-141. [PMID: 33433856 PMCID: PMC8119558 DOI: 10.1007/s40122-020-00227-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Interventional techniques such as radiofrequency (RF) treatment can be used to interrupt pain signals transmitted through the sympathetic nervous system (SNS). RF treatments including the pulsed (PRF) and continuous (CRF) modalities show enhanced control over lesion size and enhanced ability to confirm accurate positioning compared to other interventional methods. PRF also acts to reduce the area of the lesion. In this article, we characterize the currently available evidence supporting the use and efficacy of RF treatments in sympathetically mediated pain (SMP) conditions. Study Design A comprehensive literature review. Methods A PubMed and Cochrane Library database search was performed for human studies applying RF treatment at sympathetic sites (sphenopalatine ganglion, stellate ganglion, cervical, thoracic, or lumbar sympathetic ganglia, celiac plexus, splanchnic nerves, superior hypogastric plexus, and ganglion impar) between January 1970 to May 2020. Data were extracted, summarized into tables, and qualitatively analyzed. Results PRF and CRF both show promise in relieving SMP conditions, such as complex regional pain syndrome (CRPS), pain in the perineal region, headache and facial pain, and oncologic and non-oncologic abdominal pain, in addition to other types of pain, with minimal complications. Furthermore, in most comparative studies, outcomes using RF treatments exceeded other interventional techniques, such as anesthetic block and chemical neurolysis. Conclusions RF treatments can be effective in carefully selected patients who are refractory to conservative management. However, further randomized controlled studies are needed prior to implementing it into common practice.
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Low-temperature plasma radiofrequency ablation for the management of refractory cluster headache. Wideochir Inne Tech Maloinwazyjne 2020; 16:362-368. [PMID: 34136032 PMCID: PMC8193752 DOI: 10.5114/wiitm.2020.100739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/16/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Although the sphenopalatine ganglion (SPG) has been considered a site of therapeutic potential for cluster headache (CH), the optimal technique of SPG is still to be determined. Low-temperature plasma radiofrequency ablation (LTPRA) has been proposed as an alternative treatment for several neuropathic pain diseases. Aim To evaluate the effect of LTPRA of SPG in treating chronic and episodic CH. Material and methods The patients with CH, who achieved temporary pain relief following SPG block, treated using LTPRA between January 2015 and October 2017 were reviewed. Seventy-six patients were included: 50 patients suffered from episodic CH and the remaining 26 patients from chronic CH. The primary outcomes were clinical improvement rate, defined as the percentage of partial and complete pain relief results at 1 day, 12 months, and 24 months of follow-up after the operation. Results Clinical improvement rates were 92.3%, 92.3% and 73.1% in chronic CH and 73.1%, 84% and 68% in episodic CH at each follow-up time point, respectively. 3 chronic CH patients and 7 episodic CH patients showed no pain relief after the operation. Drooping eyelids were found in 2 cases, one recovered at the 3-month follow-up but another one did not in the 24-month follow-up. No serious complications occurred intraoperatively or postoperatively. Conclusions LTPRA can be considered an effective and alternative surgical modality in treating patients with chronic and episodic CH, based on SPG block.
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YANG Q, WANG RH, YANG P, MA XX, WANG D. Case of Sluder's syndrome Sluder综合征案. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2020. [DOI: 10.1016/j.wjam.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sphenopalatine ganglion-targeted low-temperature plasma radiofrequency ablation in the treatment of refractory cluster headache. Wideochir Inne Tech Maloinwazyjne 2020; 15:313-318. [PMID: 32489492 PMCID: PMC7233156 DOI: 10.5114/wiitm.2020.93529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/16/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Cluster headache (CH) is a refractory headache. Low-temperature plasma radiofrequency ablation is a relatively novel technique with promising applications in neuropathic pain. It may improve the treatment of CH. Aim To evaluate the efficacy and safety of sphenopalatine ganglion-targeted low-temperature plasma radiofrequency ablation in the treatment of patients with refractory CH. Material and methods A retrospective cohort study including seventy-five patients with refractory cluster headache who underwent computed tomography (CT)-guided sphenopalatine ganglion-targeted low-temperature plasma radiofrequency ablation between January 2015 and December 2017 at the Beijing Xuanwu Hospital was conducted. Results Effective pain relief rate 3 months after the procedure was 96% with 40 (53.3%) patients achieving complete relief; 32 (42.7%) patients obtained partial relief and 3 (4%) patients showed no relief. The effective pain relief rate two years after the procedure remained as high as 85.3% with 29 (38.6%) achieving complete relief, 35 (46.7%) partial relief and 11 (14.7%) no relief. The procedure proved equally effective for both episodic and chronic cluster headache. Complications including facial numbness, masseter weakness, facial hypoesthesia and cheek hematoma were observed, but all were mild and disappeared within 6 months. Conclusions CT-guided low-temperature plasma radiofrequency ablation is an effective and safe strategy for refractory cluster headache. For patients who have not responded to conservative treatment, this minimally invasive intervention is a reliable alternative.
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Kelderman T, Vanschoenbeek G, Crombez E, Paemeleire K. Safety and efficacy of percutaneous pulsed radiofrequency treatment at the C1-C2 level in chronic cluster headache: a retrospective analysis of 21 cases. Acta Neurol Belg 2019; 119:601-605. [PMID: 31482444 DOI: 10.1007/s13760-019-01203-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022]
Abstract
We performed a study of the safety and efficacy of percutaneous pulsed radiofrequency (PRF) treatment directed at C1 and C2 levels as performed at our local pain clinic in refractory chronic cluster headache (CCH) patients. We identified 21 CCH patients treated with PRF (240 s, max. 45 V, max. 42 °C) directed at the ganglion and/or nerve root of C1 and C2. Data were collected through retrospective analysis of patients' files and include demographic variables, onset and duration of the headache, mean attack frequency, and prior pharmacological treatment. Safety and reduction of attack frequency in the first 3 months after a first PRF treatment was the primary outcome parameter of this study. All patients had been treated with at least two prophylactic drugs and 19 (90%) had previously been treated with verapamil, lithium, and topiramate. Ten patients (47.6%) reported no meaningful effect, four patients (19%) reported a meaningful reduction of < 50%, and seven patients (33.3%) reported a reduction in headache burden of at least 50% in the 3 months following treatment. Two patients reported occurrence or increase in frequency of contralateral cluster attacks. No other adverse events were reported or detected at follow-up. Upper cervical PRF treatment appears to be a safe procedure that could prove effective in the treatment of patients with refractory CCH and warrants a prospective study.
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Efficacy and safety of surgical treatment of cluster headache. Med Clin (Barc) 2019; 154:75-79. [PMID: 31753322 DOI: 10.1016/j.medcli.2019.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/16/2019] [Accepted: 03/07/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Cluster headache (CR) is the most severe human headache and is chronic in 10%-20% of patients, and 10% can become refractory to all effective drugs. In this scenario, surgical procedures are indicated: radiofrequencies of the sphenopalatine ganglion ipsilateral to pain (RF-SPG), bilateral stimulation of the occipital nerves (NOM-S) and deep brain stimulation (DBS) of the ipsilateral posterior hypothalamus. The efficacy and safety of each of these procedures has been specifically analyzed, but the progress of a series of patients following this surgical route in order of aggressiveness has not been described. PATIENTS Patients with chronic and refractory CR according to the criteria of the European Headache Federation. The patients underwent RF-SPG, NOM-S sequentially if the previous procedure had been ineffective, and DBS if the previous procedure had been ineffective. RESULTS We prospectively included 44 patients between November 2003 and June 2018 with an average age of 38.3 years; 70% were men. The mean follow-up was 87.4 months. Nineteen patients responded to 74 procedures of RF-SPG (33.3%). Of the remaining 25 patients, a NOM-S device was implanted in 22, showing an efficacy of 50%. Finally, 9 patients underwent ECP of the ipsilateral lower-posterior hypothalamus with an efficacy of 88.8%. No serious complications were found following any of these 3 procedures. CONCLUSIONS The sequential application of these three surgical procedures succeeded in reversing the serious situation of chronic CR refractory to an episodic CR in 93% of patients with acceptable surgical morbidity.
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Chen Z, Ren H, Zhao C, Luo F. Long-term Outcomes of Computerized Tomography-Guided Sphenopalatine Ganglion-Targeted Pulsed Radiofrequency for Refractory Cluster Headache. Pain Pract 2019; 20:289-296. [PMID: 31677216 DOI: 10.1111/papr.12853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/13/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To further evaluate the efficacy and safety of computerized tomography-guided sphenopalatine ganglion-targeted pulsed radiofrequency treatment for patients with refractory episodic and chronic cluster headache (CH). METHODS Forty-five patients with refractory episodic CH and 14 patients with chronic CH who underwent computerized tomography-guided sphenopalatine ganglion-targeted pulsed radiofrequency between January 2011 and December 2018 at the Beijing Tiantan Hospital were included and analyzed in this retrospective cohort study. RESULTS A total of 59 patients underwent 106 computerized tomography-guided pulsed radiofrequency procedures throughout the observational period. Effective remission was observed in 95.6% and 64.3% of patients with refractory episodic and chronic CH, respectively. Repeated computerized tomography-guided sphenopalatine ganglion-targeted pulsed radiofrequency procedures for recurrent CH was also proven to be effective. No severe side effects or complications were observed in this study. CONCLUSION The computerized tomography-guided sphenopalatine ganglion-targeted pulsed radiofrequency procedure is an effective, safe, and repeatedly effective strategy for refractory CH. For patients who have not responded to conservative treatment, this minimally invasive intervention is a reliable alternative.
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Affiliation(s)
- Zheng Chen
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Ren
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunmei Zhao
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Kaye AD, Motejunas MW, Cornett EM, Ehrhardt KP, Novitch MB, Class J, Siddaiah H, Hart BM, Urman RD. Emerging Novel Pharmacological Non-opioid Therapies in Headache Management: a Comprehensive Review. Curr Pain Headache Rep 2019; 23:53. [PMID: 31286276 DOI: 10.1007/s11916-019-0808-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Chronic headache is a significant worldwide problem despite advances in treatment options. Chronic headaches can have significant a detrimental impact on the activities of daily living. RECENT FINDINGS Patients who do not obtain relief from chronic head and neck pain from conservative treatments are commonly being managed with interventional treatments. These interventional treatment options include botulinum toxin A, injections, local occipital nerve anesthetic and corticosteroid infiltration, occipital nerve subcutaneous stimulation and occipital nerve pulsed radiofrequency (PRF), sphenopalatine ganglion block, and radiofrequency techniques. Recently, evidence has emerged to support non-opioid-based drug and interventional approaches. Overall, more research is necessary to clarify the safety and efficacy of interventional treatments and to better understand the pathogenesis of chronic headache pain.
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Affiliation(s)
- Alan David Kaye
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave, New Orleans, LA, 70112, USA
| | - Mark W Motejunas
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave, New Orleans, LA, 70112, USA
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Ken P Ehrhardt
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave, New Orleans, LA, 70112, USA
| | - Matthew B Novitch
- University of Washington Anesthesiology, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Joshua Class
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Harish Siddaiah
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Brendon M Hart
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
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Tajti J, Szok D, Nyári A, Vécsei L. Therapeutic strategies that act on the peripheral nervous system in primary headache disorders. Expert Rev Neurother 2019; 19:509-533. [DOI: 10.1080/14737175.2019.1615447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- János Tajti
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Délia Szok
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Aliz Nyári
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
- MTA-SZTE Neuroscience Research Group of the Hungarian Academy of Sciences, Szeged, Hungary
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15
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Liu SC, Kao MC, Huang YC, Su WF. Vidian Neurectomy for Management of Chronic Cluster Headache. Neurosurgery 2019; 84:1059-1064. [PMID: 30535031 DOI: 10.1093/neuros/nyy136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/19/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Management of chronic cluster headache (CCH) remains a challenging endeavor, and the optimal surgical approach for medically refractory CCH remains controversial. OBJECTIVE To conduct a preliminary evaluation of the efficacy and safety of vidian neurectomy (VN) in patients with medically refractory CCH. METHODS Between March 2013 and December 2015, 9 CCH patients, all of whom had failed to respond to conservative therapy, underwent VN with a precise nerve cut and maximal preservation of the sphenopalatine ganglion. Data included demographic variables, cluster headache onset and duration, mean attack frequency, mean attack intensity, and pain disability index measures pre- and through 12-mo postsurgery. RESULTS Seven of the 9 cases (77.8%) showed immediate improvement. Improvement was delayed by 1 mo in 1 patient, after which the surgical effects of pain relief were maintained throughout the follow-up period. One patient (11.1%) did not improve after surgery. One year after VN, patients' mean attack frequency, mean attack intensity, and pain disability index decreased by 54.5%, 52.9%, and 56.4%, respectively. No patient experienced treatment-related side effects or complications. CONCLUSION VN is an effective treatment method for CCH patients. Precise Vidian nerve identification and maximal preservation of the sphenopalatine ganglion may achieve good surgical outcomes and dramatically improve quality of life among patients, without significant adverse events.
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Affiliation(s)
- Shao-Cheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ming-Chang Kao
- Division of Pain Medicine, Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, Republic of China.,School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China
| | - Yun-Chen Huang
- School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China.,Department of Otolaryngology-Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, Republic of China
| | - Wan-Fu Su
- School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China.,Department of Otolaryngology-Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, Republic of China
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Li J, Ren H, Wang B, Wu D, Luo F. Multicentre, prospective, randomised, controlled, blinded-endpoint study to evaluate the efficacy and safety of pterygopalatine ganglion pulsed radiofrequency treatment for cluster headache: study protocol. BMJ Open 2019; 9:e026608. [PMID: 30904875 PMCID: PMC6475260 DOI: 10.1136/bmjopen-2018-026608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Single-centre reports on small groups of patients have shown that pterygopalatine ganglion pulsed radiofrequency treatment in patients with refractory cluster headache (CH) can quickly relieve pain without significant side effects. However, a randomised controlled trial is still necessary to evaluate whether pterygopalatine ganglion pulsed radiofrequency (PRF) treatment is a viable treatment option for patients with CH who are not responding to drug treatment. METHODS AND ANALYSIS This investigation is a multicentre, prospective, randomised, controlled, blinded-endpoint study. We will enrol 80 patients with CH who are not responding to medication. The enrolled patients will be randomly divided into two groups: the nerve block (NB) group and the PRF group. All patients will undergo CT-guided pterygopalatine ganglion puncture. A mixture containing steroids and local anaesthetics will be slowly injected into the patients in the NB group. The patients in the PRF group will be treated with PRF at 42°C for 360 s. After treatment, the duration of cluster periods; degree of pain during headache attacks; frequency of headache attacks; duration of each headache attack; dose of auxiliary analgesic drugs; duration of remission; degree of patient satisfaction; effectiveness rates at 1 day, 3 days, 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year after the procedure; and intraoperative and postoperative adverse events will be compared between the two groups. ETHICS AND DISSEMINATION This study was approved by the institutional ethics committee of the Beijing Tiantan Hospital (approval number: KY 2018-027-02). The results of the study will be published in peer-reviewed journals, and the findings will be presented at scientific meetings. TRIAL REGISTRATION NUMBER NCT03567590; Pre-results.
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Affiliation(s)
- Jin Li
- Department of Anesthesiology and Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Ren
- Department of Anesthesiology and Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baoguo Wang
- Department of Anesthesiology, Beijing Sanbo Brian Hospital, Capital Medical University, Beijing, China
| | - Dasheng Wu
- Department of Pain Management, Jilin Province People’s Hospital, Changchun, China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Cluster headache: crosspoint between otologists and neurologists—treatment of the sphenopalatine ganglion and systematic review. Neurol Sci 2019; 40:137-146. [DOI: 10.1007/s10072-019-03796-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Crespi J, Bratbak D, Dodick D, Matharu M, Jamtøy KA, Tronvik E. Prediction of the sphenopalatine ganglion localization in computerized tomography images. CEPHALALGIA REPORTS 2019. [DOI: 10.1177/2515816318824690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The sphenopalatine ganglion (SPG) is a target for several headache syndromes. Most of the groups targeting the SPG do not localize it directly, and this might account for some therapeutic failures. As the SPG cannot be seen on computerized tomography (CT) scans, magnetic resonance image (MRI) must be used to visualize the ganglion. It would be advantageous to be able to predict the location of the SPG on CT scans for those using fluoroscopy or CT-guided injections and for those in whom MRI is not accessible or contraindicated. Methods: We localized the SPG in 21 Caucasian patients (21 right and 17 left ganglia; total 38) in 3 tesla MR images subsequently fused with CT scans. We measured the distance from the SPG to two bony landmarks identified on CT scans. We then applied the average distances to find an estimated position of the SPG. The first landmark was the center of the anterior opening of the vidian canal (VC). The second landmark was a point on the sphenoidal bone, defined in an axial plane at the level of the center of the VC (S-point). The predicted position of the SPG measured from the VC and the sphenoidal bone were referred to as, respectively, vcSPG and sSPG. Finally, the distances between the SPG, as seen on MRI, and predicted vcSPG/sSPG were calculated. Results: The average distance between SPG as seen on the MRI images and the estimated position based on CT images were 1.82 mm (SD 0.83, range 0.22–3.57 mm) for vcSPG and 2.09 mm (SD 0.99, range 0.71–4.79 mm) for sSPG. Conclusions: The localization of the SPG can be predicted on CT images using bony landmarks. Localization of the SPG may be important in achieving successful therapeutic outcomes for treatments that are directed toward the SPG.
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Affiliation(s)
- Joan Crespi
- Department of Neurology, St Olav’s University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian Advisory Unit on Headaches, Trondheim, Norway
| | - Daniel Bratbak
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Neurosurgery, St Olav’s University Hospital, Trondheim, Norway
| | - David Dodick
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Mayo Clinic, Phoenix, AZ, USA
| | - Manjit Matharu
- UCL Queen Square Institute of Neurology and The National Hospital of Neurology and Neurosurgery, London, UK
| | - Kent Are Jamtøy
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Maxillofacial Surgery, St Olav’s University Hospital, Trondheim, Norway
| | - Erling Tronvik
- Department of Neurology, St Olav’s University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian Advisory Unit on Headaches, Trondheim, Norway
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Salgado-López L, de Quintana-Schmidt C, Belvis Nieto R, Roig Arnall C, Rodríguez Rodriguez R, Álvarez Holzapfel MJ, Molet-Teixidó J. Efficacy of Sphenopalatine Ganglion Radiofrequency in Refractory Chronic Cluster Headache. World Neurosurg 2018; 122:e262-e269. [PMID: 30315985 DOI: 10.1016/j.wneu.2018.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/01/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the literature, there are only short series of radiofrequency of the sphenopalatine ganglion (SPG) to treat chronic refractory cluster headache (CCHr) with variable results. Furthermore, there is no consensus on which methodology to use: radiofrequency ablation (RFA) or pulsed radiofrequency (PRF). METHODS We conducted a prospective analysis of 37 patients with CCHr who underwent RFA or PRF of the SPG in our center between 2004 and 2015. RESULTS The mean age of the patients was 40 years (range, 26-59 years). PRF was performed in 24 patients, and RFA was performed in 13 patients. A total of 5 patients (13.5%) experienced complete clinical relief of both pain and parasympathetic symptoms, 21 patients (56.8%) had partial and transient relief, and 11 patients (29.7%) did not improve. There was no evidence of significant superiority of one radiofrequency modality over the other (P = 0.48). There were no complications associated with the technique. The passage of time tended to decrease the efficacy of both techniques (P < 0.001). The mean follow-up was 68.1 months (range, 15-148 months). To our knowledge, this is the series with the largest number of patients and the longest follow-up period published in the literature. CONCLUSIONS Radiofrequency of the SPG is a safe, fast, and partially effective method for the treatment of CCHr. Given its low rate of complications and its low economic cost, we think it should be one of the first invasive treatment options, prior to techniques with greater morbidity and mortality, such as neuromodulation.
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Affiliation(s)
- Laura Salgado-López
- Department of Neurosurgery, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | | | - Robert Belvis Nieto
- Department of Neurology, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carles Roig Arnall
- Department of Neurology, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Joan Molet-Teixidó
- Department of Neurosurgery, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Gai J, Gao Z, Song L, Xu Y, Liu W, Zhao C. Contrast-enhanced computed tomography combined with Chitosan-Fe 3O 4 nanoparticles targeting fibroblast growth factor receptor and vascular endothelial growth factor receptor in the screening of early esophageal cancer. Exp Ther Med 2018; 15:5344-5352. [PMID: 29805549 PMCID: PMC5958695 DOI: 10.3892/etm.2018.6087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/28/2017] [Indexed: 12/14/2022] Open
Abstract
Esophageal cancer is a malignant tumor with a relatively high invasiveness, metastatic potential and worldwide incidence among human cancers. The majority of patients with esophageal cancer are diagnosed in a late tumor stage due to a lack of advanced and sensitive protocols for the diagnosis of patients with early-stage esophageal cancer. In the current study, contrast-enhanced computerized tomography (CECT) combined with Chitosan-Fe3O4 nanoparticles targeting fibroblast growth factor receptor (FGFR) and vascular endothelial growth factor receptor (VEGFR; CECT-CNFV) were used to diagnose patients with suspected esophageal cancer. A Chitosan-Fe3O4-parceled bispecific antibody targeting FGFR and VEGFR was produced and its affinity to esophageal cancer cells was determined both in vitro and in vivo. A total of 320 patients with suspected esophageal cancer were voluntarily recruited to evaluate the efficacy of CECT-CNFV in the diagnosis of early-stage esophageal cancer. All participants were subjected to CT and CECT-CNFV to detect whether tumors were present in the esophageal area. A Chitosan-Fe3O4 nanoparticles contrast agent was orally administered at 20 min prior to CT and CECT-CNFV. The results demonstrated that CECT-CNFV improved diagnostic sensitivity and provided a novel protocol for the diagnosis of tumors in patients with suspected gastric cancer at an early-stage. Furthermore, the resolution ratio of images was enhanced by CECT-CNFV, which enabled the visualization of tiny tumor nodules in esophageal tissue. Clinical data demonstrated that CECT-CNFV diagnosed 200 patients with suspected early-stage esophageal cancer and 120 patients as tumor free. In addition, CECT-CNFV exhibited higher signal enhancement of tumor nodules than CT, suggesting a higher accuracy and accumulation of nanoparticle contrast agent within the tumor nodules of esophageal tissue. Notably, the survival rate of patients with esophageal cancer diagnosed at an early-stage by CECT-CNFV was higher than the mean five-year survival rate (P<0.01). In conclusion, CECT-CNFV enhanced the sensitivity and accuracy of CT in the diagnosis of early-stage esophageal cancer. Thus, CECT-CNFV may improve the accuracy of CT in the diagnosis of mural enhancement in patients with esophageal cancer.
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Affiliation(s)
- Juanjuan Gai
- Department of Radiology, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
| | - Zhenli Gao
- Department of Radiology, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
| | - Liqiang Song
- Department of Oncology, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
| | - Yongyun Xu
- Department of Computed Tomography, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
| | - Weixin Liu
- Department of Oncology, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
| | - Chuanxin Zhao
- Department of Joint Surgery, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
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Abstract
Cluster headache (CH) is a debilitating primary headache disorder. Although uncommon, affecting only 0.1% of population, it is one of the most painful conditions known to humankind. Three strategies are employed for effective treatment of CH, namely, abortive therapy, transitional therapy, and preventive therapy. Being an uncommon condition, there is a paucity of large-scale controlled trials and evidence of various therapies are based on smaller studies. This review primarily focuses on therapies with highest quality of evidence and also on the emerging therapies for CH.
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Affiliation(s)
- William S. Kingston
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, ON, USA
| | - David W. Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
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Ho KWD, Przkora R, Kumar S. Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review. J Headache Pain 2017; 18:118. [PMID: 29285576 PMCID: PMC5745368 DOI: 10.1186/s10194-017-0826-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/24/2017] [Indexed: 12/02/2022] Open
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. Electronic supplementary material The online version of this article (10.1186/s10194-017-0826-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kwo Wei David Ho
- Department of Neurology, University of Florida, PO Box 100236,1149 Newell Drive, Room L3-100, Gainesville, FL, 32611, USA.
| | - Rene Przkora
- Department of Anesthesiology, University of Florida, 1600 SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA
| | - Sanjeev Kumar
- Department of Anesthesiology, University of Florida, 1600 SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA
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