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

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.