Two-Stage Sphenopalatine Ganglion Neurostimulation for Refractory Craniofacial Pain: A Retrospective Study

Area of Science:

• Neurosurgery
• Pain Management
• Neuromodulation

Background:

• The sphenopalatine ganglion (SPG) is implicated in craniofacial pain syndromes.
• SPG neuromodulation is a therapeutic target, but patient selection and efficacy in diverse pain conditions require definition.

Purpose of the Study:

• To assess the feasibility and safety of a two-stage SPG neurostimulation protocol for selecting patients with refractory craniofacial pain.
• To evaluate the efficacy of SPG neurostimulation across heterogeneous craniofacial pain conditions.

Main Methods:

• Retrospective case series of nine patients with medication-refractory chronic craniofacial pain.
• SPG electrode trial implantation via a lateral infrazygomatic approach under fluoroscopic guidance.
• Evaluation of technical feasibility, safety, and clinical effectiveness using Numeric Rating Scale (NRS) and attack frequency.

Main Results:

• 78% of patients (7/9) experienced significant pain reduction (30-90%) during the trial.
• Neuropathic facial pain showed superior outcomes (85% reduction) compared to chronic cluster headache (65% reduction).
• Two major complications occurred: maxillary artery hemorrhage (n=2) and device explantation for infection/ulcer (n=1 each).

Conclusions:

• The two-stage SPG neurostimulation protocol effectively identifies suitable candidates for permanent implantation.
• Differential responses suggest the need for condition-specific trial protocols, potentially longer for episodic pain.
• This approach optimizes patient selection for SPG neuromodulation therapy.