Cranial Nerve Targets

  • Jill E. SindtEmail author


Cancers of the head and neck account for less than 5% of cancers diagnosed in the United States each year, but they are among the cancers most likely to cause significant cancer-associated pain. Pain can affect a variety of anatomic locations and tissue types in the head and neck and be a result of direct tumor invasion, compression of nervous structures, and damage during surgical intervention or as a sequelae of radiation treatment. Multiple modalities exist for interventional treatment of head and neck pain, including local anesthetic nerve block, chemical neurolysis, thermal or pulsed radiofrequency ablation, cryoablation, and peripheral nerve stimulation. Common targets for intervention consist of cranial nerves such as the trigeminal ganglion, including its major divisions and terminal branches, the glossopharyngeal nerve and the vagus nerve. Other non-cranial nerve targets include the sphenopalatine ganglion, temporomandibular joint, greater and lesser occipital nerves and the cervical plexus.


Trigeminal neuralgia Glossopharyngeal neuralgia Vagal neuralgia Occipital neuralgia Sphenopalatine ganglion Cervical plexus Temporomandibular joint Radiofrequency ablation Neurolysis Cryoablation Peripheral nerve stimulation 


  1. 1.
    Davies L, Welch HG. Epidemiology of head and neck cancer in the United States. Otolaryngol Head Neck Surg. 2006;135(3):451–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Breivik H, Cherny N, Collett B, De Conno F, Filbet M, Foubert AJ, et al. Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol. 2009;20(8):1420–33.PubMedCrossRefGoogle Scholar
  3. 3.
    van den Beuken-van Everdingen MHJ, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007;18(9):1437–49.PubMedCrossRefGoogle Scholar
  4. 4.
    List MA, Stracks J, Colangelo L, Butler P, Ganzenko N, Lundy D, et al. How do head and neck cancer patients prioritize treatment outcomes before initiating treatment? J Clin Oncol. 2000;18(4):877–84.PubMedCrossRefGoogle Scholar
  5. 5.
    Hammerlid E, Bjordal K, Ahlner-Elmqvist M, Boysen M, Evensen JF, Biörklund A, et al. A prospective study of quality of life in head and neck cancer patients. Part I: at diagnosis. Laryngoscope. 2001;111(4 Pt 1):669–80.PubMedCrossRefGoogle Scholar
  6. 6.
    Bjordal K, Elmqvist MA, Hammerlid E. A prospective study of quality of life in head and neck cancer patients. Part II: longitudinal data. Laryngoscope. 2001;111:1440–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Sanderson RJ, Ironside J. Squamous cell carcinomas of the head and neck. BMJ. 2002;325:822–7.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Caraceni A, Portenoy RK. An international survey of cancer pain characteristics and syndromes. IASP task force on Cancer pain. International Association for the Study of Pain. Pain. 1999;82(3):263–74.PubMedCrossRefGoogle Scholar
  9. 9.
    Hickey AH, Scrivani SS, Bajwa ZH. Cranial Neuralgias. In: Fishman SM, Ballantyne JC, Rathmell JP, editors. Bonica’s Management of Pain. 4th ed. Baltimore: Lippincott Williams and Wilkins; 2010. p. 953–71.Google Scholar
  10. 10.
    Erdine S. Interventional treatment of cancer pain. Eur J Cancer Supp. 2005;3(3):97–106.CrossRefGoogle Scholar
  11. 11.
    Day M. Neurolysis of the trigeminal and sphenopalatine ganglions. Pain Pract. 2001;1(2):171–82.PubMedCrossRefGoogle Scholar
  12. 12.
    Saini SS. Reterogasserian anhydrous glycerol injection therapy in trigeminal neuralgia: observations in 552 patients. J Neurol Neurosurg Psychiatry. 1987;50(11):1536–8.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Peters G, Nurmikko TJ. Peripheral and gasserian ganglion-level procedures for the treatment of trigeminal neuralgia. Clin J Pain. 2002;18(1):28–34.PubMedCrossRefGoogle Scholar
  14. 14.
    Ischia S, Luzzania A, Polati E. Retrogasserian glycerol injections: a retrospective study of 112 patients. Clin J Pain. 1990;6(4):291–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Mendelsohn D, Ranjan M, Hawley P, Honey CR. Percutaneous trigeminal rhizotomy for facial pain secondary to head and neck malignancy. Clin J Pain. 2013;29(10):e4–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Waldman SD. Gasserian ganglion block radiofrequency lesioning. In: Waldman SD, editor. Atlas of interventional pain management. 3rd ed. Philadelphia: Saunders Elsevier; 2009. p. 38–44.Google Scholar
  17. 17.
    Spincemaille GH, Dingemans W, Lodder J. Percutaneous radiofrequency Gasserian ganglion coagulation in the treatment of trigeminal neuralgia. Clin Neurol Neurosurg. 1985;87(2):91–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Kanpolat Y, Savas A, Bekar A, Berk C. Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1,600 patients. Neurosurgery. 2001;48(3). 524–32–discussion 532–4PubMedCrossRefGoogle Scholar
  19. 19.
    Fraioli B, Esposito V, Guidetti B, Cruccu G, Manfredi M. Treatment of trigeminal neuralgia by Thermocoagulation, Glycerolization, and percutaneous compression of the gasserian ganglion and/or retrogasserian rootlets: long-term results and therapeutic protocol. Neurosurgery. 1989;24(2):239.PubMedCrossRefGoogle Scholar
  20. 20.
    Skirving DJ, Dan NG. A 20-year review of percutaneous balloon compression of the trigeminal ganglion. J Neurosurg. 2001;94(6):913–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Nguyen M, Wilkes D. Pulsed radiofrequency V2 treatment and intranasal sphenopalatine ganglion block: a combination therapy for atypical trigeminal neuralgia. Pain Pract. 2010;10(4):370–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Singh B, Srivastava SK, Dang R. Anatomic considerations in relation to the maxillary nerve block. Reg Anesth Pain Med. 2001;26(6):507–11.PubMedCrossRefGoogle Scholar
  23. 23.
    Kohase H, Umino M, Shibaji T, Suzuki N. Application of a mandibular nerve block using an indwelling catheter for intractable cancer pain. Acta Anaesthesiol Scand. 2004;48(3):382–3.PubMedCrossRefGoogle Scholar
  24. 24.
    Takemura H, Masuda Y, Yatsushir R. Mandibular nerve block treatment for trismus associated with hypoxic-ischemic encephalopathy. Reg Anesth Pain Med. 2002;27(3):313–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Wells J. The use of nerve destruction for relief of pain in cancer: a review. Palliat Med. 1989;3(4):239–47.CrossRefGoogle Scholar
  26. 26.
    Wilkinson HA. Trigeminal nerve peripheral branch phenol/glycerol injections for tic douloureux. J Neurosurg. 1999;90(5):828–32.PubMedCrossRefGoogle Scholar
  27. 27.
    Lee HJ, Choi KS, Won SY, et al. Topographic Relationship between the Supratrochlear Nerve and Corrugator Supercilii Muscle—Can This Anatomical Knowledge Improve the Response to Botulinum Toxin Injections in Chronic Migraine? Toxins. 2015;7:2629–38.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Koyyalagunta D, Mazloomdoost D. Radiofrequency and cryoablation for cancer pain. Tech Reg Anesth Pain Med. 2010;14:3–9.CrossRefGoogle Scholar
  29. 29.
    Osenbach R. Neurostimulation for the treatment of intractable facial pain. Pain Med. 2006;7(S1):S126–36.CrossRefGoogle Scholar
  30. 30.
    Vaisman J, Markley H, Ordia J. The treatment of medically intractable trigeminal autonomic cephalalgia with supraorbital/supratrochlear stimulation: a retrospective case series. Neuromodulation. 2012;15:374–80.PubMedCrossRefGoogle Scholar
  31. 31.
    Rahman M, Richter EO, Osawa S, Rhoton AL. Anatomic study of the infraorbital foramen for radiofrequency neurotomy of the infraorbital nerve. Neurosurgery. 2009;64(5 Suppl 2):423–7.PubMedGoogle Scholar
  32. 32.
    Erdem E, Alkan A. Peripheral glycerol injections in the treatment of idiopathic trigeminal neuralgia: retrospective analysis of 157 cases. J Oral Maxillofac Surg. 2001;59(10):1176–80.PubMedCrossRefGoogle Scholar
  33. 33.
    Faltas B, Phatak P, Sham R. Mental nerve neuropathy: frequently overlooked clinical sign of hematologic malignancies. Am J Med. 2011;124(1):e1–2.PubMedCrossRefGoogle Scholar
  34. 34.
    Park HG, Park PG, Kim WJ, Park YH, Kang H, Baek CW, et al. Ultrasound-assisted mental nerve block and pulsed radiofrequency treatment for intractable postherpetic neuralgia: three case studies. Korean J Pain. 2014;27(1):81–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Trescot AM. Cryoanalgesia in interventional pain management. Pain Physician. 2003;6(3):345–60.PubMedGoogle Scholar
  36. 36.
    Kandan SR, Khan S, Jeyaretna DS, Lhatoo S, Patel NK, Coakham HB. Neuralgia of the glossopharyngeal and vagal nerves: long-term outcome following surgical treatment and literature review. Br J Neurosurg. 2010;24(4):441–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Shin HY, Park HJ, Choi Y-C, Kim SM. Clinical and electromyographic features of radiation-induced lower cranial neuropathy. Clin Neurophysiol. 2013;124(3):598–602.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Shah RV, Racz GB. Pulsed mode radiofrequency lesioning to treat chronic post-tonsillectomy pain (secondary glossopharyngeal neuralgia). Pain Pract. 2003;3(3):232–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Waldman SD. Vagus nerve block. In: Waldman SD, editor. Atlas of interventional pain management. 3rd ed. Philadelphia: Saunders Elsevier; 2009. p. 104–7.Google Scholar
  40. 40.
    Windsor RE, Jahnke S. Sphenopalatine ganglion blockade: a review and proposed modification of the transnasal technique. Pain Physician. 2004;7(2):283–6.PubMedGoogle Scholar
  41. 41.
    Varghese BT, Koshy RC, Sebastian P, Joseph E. Combined sphenopalatine ganglion and mandibular nerve, neurolytic block for pain due to advanced head and neck cancer. Palliat Med. 2002;16(5):447–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Day M. Sympathetic blocks: the evidence. Pain Pract. 2008;8(2):98–109.PubMedCrossRefGoogle Scholar
  43. 43.
    Bayer E, Racz GB, Miles D, Heavner J. Sphenopalatine ganglion pulsed radiofrequency treatment in 30 patients suffering from chronic face and head pain. Pain Pract. 2005;5(3):223–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Kim M-J, Ye Y-M, Park H-S, Suh C-H. Chemotherapy-related arthropathy. J Rheumatol. 2006;33(7):1364–8.PubMedGoogle Scholar
  45. 45.
    Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008;359(25):2693–705.PubMedCrossRefGoogle Scholar
  46. 46.
    Guarda-Nardini L, Stifano M, Brombin C, Salmaso L, Manfredini D. A one-year case series of arthrocentesis with hyaluronic acid injections for temporomandibular joint osteoarthritis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(6):e14–22.PubMedCrossRefGoogle Scholar
  47. 47.
    Waldman SD. Temporomandibular joint injection. In: Waldman SD, editor. Atlas of pain injection techniques. 3rd ed. Philadelphia: Saunders Elsevier; 2013. Ch 1.Google Scholar
  48. 48.
    Ward JB. Greater occipital nerve block. Semin Neurol. 2003;23(1):59–62.PubMedCrossRefGoogle Scholar
  49. 49.
    Ducic I, Felder JM, Endara M. Postoperative headache following acoustic neuroma resection: occipital nerve injuries are associated with a treatable occipital neuralgia. Headache. 2012;52(7):1136–45.PubMedCrossRefGoogle Scholar
  50. 50.
    Navani A, Mahajan G, Kreis P, Fishman SM. A case of pulsed radiofrequency lesioning for occipital neuralgia. Pain Med. 2006;7(5):453–6.PubMedCrossRefGoogle Scholar
  51. 51.
    Shim JH, Ko SY, Bang MR, Jeon WJ, Cho SY, Yeom JH, et al. Ultrasound-guided greater occipital nerve block for patients with occipital headache and short term follow up. Korean J Anesthesiol. 2011;61(1):50–4.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Skaribas I, Aló K. Ultrasound imaging and occipital nerve stimulation. Neuromodulation. 2010;13(2):126–30.PubMedCrossRefGoogle Scholar
  53. 53.
    Fredriksen TA. Cervicogenic headache: invasive procedures. Cephalalgia. 2008;28(s1):39–40.PubMedCrossRefGoogle Scholar
  54. 54.
    Slavin KV, Colpan ME, Munawar N, Wess C. Trigeminal and occipital peripheral nerve stimulation for craniofacial pain: a single-institution experience and review of the literature. Neurosurg Focus. 2006;15:374–80.Google Scholar
  55. 55.
    Hong J, Ball PA, Fanciullo GJ. Neurostimulation for neck pain and headache. Headache. 2014;54(3):430–44.PubMedCrossRefGoogle Scholar
  56. 56.
    Sist T, Miner M, Lema M. Characteristics of postradical neck pain syndrome: a report of 25 cases. J Pain Symp. 1999;18:95.CrossRefGoogle Scholar
  57. 57.
    Pandit JJ, Bree S, Dillon P, Elcock D. A comparison of superficial versus combined (superficial and deep) cervical plexus block for carotid endarterectomy: a prospective, randomized study. Anest Analg. 2009;91:781–6.CrossRefGoogle Scholar
  58. 58.
    Arnér S. The role of nerve blocks in the treatment of cancer pain. Acta Anaesthesiol Scand. 1982;74(S):104–8.CrossRefGoogle Scholar
  59. 59.
    Pandit JJ, Dutta D, Morris JF. Spread of injectate with superficial cervical plexus block in humans: an anatomical study. Brit J of Anaesth. 2003;91(5):733–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University of Utah, Department of AnesthesiologySalt Lake CityUSA

Personalised recommendations