An Unusual Location for Sphenopalatine Ganglion in the Pterygopalatine Fossa Which May Facilitate Radiofrequency Neurolysis: A Case Report

In this paper we demonstrated an unusual location for sphenopalatine ganglion (SPG) in the pterygopalatine fossa in a 33-year-old woman with intractable atypical trigeminal autonomic cephalalgia, who was a candidate for radiofrequency (RF) thermocoagulation of SPG. The classic radiographic target point is deeply situated in the uppermost part of the sphenopalatine (SP) fossa. This point can be classically addressed in the superomedial angle of the maxillary sinus, adjacent to the lateral wall of the nasal cavity in the AP view of C-Arm fluoroscopy images. In this patient placing the needle deeply in the SP fossa was not possible. However, sensory stimulation of SPG was associated with a satisfactory response and subsequent RF denervation led to adequate pain reduction. This report demonstrated that in difficult technical situations, when advancing the needle deeply in the SP fossa is not easily possible; adequate outcome of the sensory stimulation of the area, may justify accomplishing the procedure. This technique used in a more superficial location in SP fossa will reduce frequent attempts of needle manipulation, hematoma formation, vascular and neural injury, X-Ray exposure and eventually intranasal placement of the needle.