ABSTRACT
Abstract
Objectives:
Cluster headache is considered a
trigeminal autonomic cephalalgia and may present with characteristic symptoms of sympathetic/parasympathetic activation on the affected side of the
face, such as nasal discharge, tearing, and conjunctival
injection. Invasive
therapies targeting the sphenopalatine
ganglion have been performed in these
headache syndromes and can have a medication-sparing effect, especially in refractory, difficult-to-manage cases. The gate control theory of
pain suggests that electric
pulses delivered to
nerve tissues can modulate neuronal activity, thus aiding in management of nociceptive or
neuropathic pain, and studies have demonstrated the
efficacy and
safety of sphenopalatine
ganglion neurostimulation. Within this context, we sought to assess the feasibility of a new surgical
technique for neurostimulation of the sphenopalatine
ganglion in a
cadaver dissection model.
Methods:
The
technique was developed through
dissection of two
cadaver heads. We divided the
procedure into two stages an endonasal endoscopic approach to expose the sphenopalatine
ganglion and confirm
electrode placement, and a cervicofacial approach to introduce the
electrode array and position the internal
pulse-generator unit. Computed
tomography was performed to confirm implant placement at the end of the
procedure.
Results:
The
pulse-generator unit was successfully placed through a retroauricular incision, as is already standard for
cochlear implant placement. This should reduce the
incidence of perioperative sequelae, especially
pain and swelling in the oral region, which are a common complication of previous approaches used for this purpose. Control imaging confirmed proper
electrode placement. The
device used in this study allows the
patient to modulate the intensity of the stimulus, reducing or even obviating the need for
drug therapy.
Conclusion:
The novel
technique described herein, based on percutaneous access guided by transmaxillary
endoscopy, can provide great precision in
electrode array positioning and decreased perioperative
morbidity, combining the advantages of endoscopic approaches with those of the retroauricular route. Level of evidence 3.