A case report: Infrazygomatic approach neurocryoablation of the sphenopalatine ganglion under cone beam computer tomography guidance in treating refractory headaches.

INTRODUCTION: The sphenopalatine ganglion (SPG) drives the cranial autonomic symptoms associated with trigeminal autonomic cephalalgias, migraine, and trigeminal neuralgia. Infrazygomatic approach SPG block serves as the gold standard for both prognostic and therapeutic intervention for management of refractory headache with autonomic symptoms. However, this intervention often provides only short-term relief. Identification of novel interventions that provide more durable relief is imperative.

CASE: An 84-year-old female with chronic headache featuring autonomic cranial symptoms that failed both medication and conservative intervention management. Patient responded well to infrazygomatic approach SPG block using combined cone beam CT and fluoroscopy guidance, however, experienced fading therapeutic response over the years. Subsequently, patient underwent neurocryoablation of the SPG, from which, satisfactory and sustained improvement of her headache pain was achieved at six month follow up.

CONCLUSION: This is the first case demonstrating the clinical feasibility and therapeutic outcomes of SPG neurocryoablation in treating refractory headaches.