Department of Neurology, University of Florida, PO Box 100236,1149 Newell Drive, Room L3-100, Gainesville, FL, 32611, USA.
Department of Anesthesiology, University of Florida, 1600 SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA.
J Headache Pain. 2017 Dec 28;18(1):118. doi: 10.1186/s10194-017-0826-y.
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.
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.
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.
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.
蝶腭神经节是颅骨外大脑以外神经元最集中的部位。在过去的一个世纪中，由于其易于接近，它一直是治疗头面部疼痛的介入治疗目标。阻滞、射频消融和神经刺激都已被应用于治疗多种疼痛综合征。尽管这些干预措施已被常规应用，但支持其应用的文献尚未得到系统总结。本系统评价旨在收集和总结支持蝶腭神经节阻滞、射频消融和神经刺激应用的证据水平。
对 Medline、Google Scholar 和 Cochrane 中央对照试验注册中心（CENTRAL）数据库进行了检索，以获取有关蝶腭神经节阻滞、射频消融和神经刺激的研究。对纳入本研究的研究进行了汇编和分析，以了解其治疗的医疗条件、研究设计、结果和程序细节。使用牛津循证医学中心的证据等级对研究进行分级。根据证据水平，对每种干预措施及其相关医疗条件提供推荐等级。
本研究共纳入 83 篇文献，其中 60 篇为蝶腭神经节阻滞研究，15 篇为射频消融研究，8 篇为神经刺激研究。所有研究中，有 23 项研究的证据水平高于病例系列。在 23 项研究中，有 19 项是关于蝶腭神经节阻滞的，1 项是关于射频消融的，3 项是关于神经刺激的。其余可用文献为病例报告和病例系列。最强的证据在于使用蝶腭神经节阻滞、射频消融和神经刺激治疗丛集性头痛。蝶腭神经节阻滞在治疗三叉神经痛、偏头痛、减少内镜鼻窦手术后镇痛药物需求以及减少鼻手术后鼻填塞取出相关疼痛方面也有证据。
总体而言，蝶腭神经节是治疗丛集性头痛的一个有前途的靶点，可采用阻滞、射频消融和神经刺激。蝶腭神经节阻滞在其他几种情况下也有一些证据支持其应用。然而，大多数对照研究规模较小，且没有重复。需要进一步的对照研究来复制和扩展这些先前的发现。
