Case Reports
Vol. 4 No. 1 (2026)
https://doi.org/10.4081/aapm.2026.63

Cryoneuromodulation of the sphenopalatine ganglion via transnasal approach in Sluder’s syndrome: a case report

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Published: 16 March 2026
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Cryoneuromodulation, sphenopalatine ganglion, Sluder’s neuralgia, chronic facial pain, cluster headache

Authors

Chiara Maggiani
maggiani.kiara@gmail.com
Department of Anesthesia, Resuscitation and Pain Therapy, Pain Therapy Outpatient Clinic, Fabrizio Spaziani Hospital, Frosinone, Italy.
Pierfrancesco Fusco
Department of Anesthesia, Resuscitation and Pain Therapy, Avezzano Hospital, Avezzano (AQ), Italy.
Fabrizio Fattorini
San Sebastiano Hospital, Frascati (RM); President of the Italian Chapter of the European Society of Regional Anesthesia & Pain Therapy, Italy.
Walter Ciaschi
Department of Anesthesia, Resuscitation and Pain Therapy, Pain Therapy Outpatient Clinic, Fabrizio Spaziani Hospital, Frosinone, Italy.

Sluder’s neuralgia is a rare form of facial pain associated with autonomic symptoms and often refractory to conventional therapies. Cryoneuromodulation provides a minimally invasive approach capable of temporarily interrupting nociceptive transmission without permanent neural damage. We describe the case of a 41-year-old male with a 15-year history of left-sided migraine-like facial pain radiating to the nasal ala and supraorbital, frontal, and occipital regions. Symptoms included lacrimation, rhinorrhea, photophobia, and tactile hyperalgesia. A diagnostic transnasal sphenopalatine ganglion (SPG) block using 2% lidocaine resulted in complete pain remission. Due to partial recurrence, fluoroscopy-guided transnasal cryoneuromodulation at −78°C was performed for 4 minutes. Immediate and sustained relief (Numerical Rating Scale [NRS] 0) was achieved and maintained at 120-day follow-up. Fluoroscopy-guided transnasal cryoneuromodulation is a safe, effective, and well-tolerated therapeutic option for Sluder’s neuralgia, offering sustained relief without neural injury. It may represent a less invasive alternative to infrazygomatic radiofrequency (RF) or stimulation approaches, with potentially improved tolerability in selected patients.

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Cryoneuromodulation of the sphenopalatine ganglion via transnasal approach in Sluder’s syndrome: a case report. (2026). Advances in Anesthesia and Pain Medicine, 4(1). https://doi.org/10.4081/aapm.2026.63
Copyright (c) 2026 Chiara Maggiani, Pierfrancesco Fusco, Fabrizio Fattorini, Walter Ciaschi Creative Commons License

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