Abstract: Objective To retrospectively analysis the therapeutic effect for viable sphenopalatine neuralgia (SPN) by image-guided (C-arm or CT-guided)sphenopalatine ganglion block combined with selective cervical paravertebral nerve block and cervical joint injection. Methods Totally 22 patients with sphenopalatine neuralgia underwent C-arm guided sphenopalatine ganglion block combined with ultrasound-guided nerve block of cervical 2-5 and cervical joint injection(1-3times,once a week). Numeric rating scales(NRS) was obtained at 24 hours, 1 month,3 months, 6 months,1 year,2 years, and 3 years after nerve block. The telephone follow-up lasted for 3-64 months,with average of (38.86±16.08) months. The therapeutic efficacy was evaluated, and the post-therapy adverse reaction was recorded. Results NRS scores significantly decreased after treatment at 24 hours, 1 month,3 months,6 months 1 year,2 years and 3 years. The effective rate after procedure was 95.45%(21/22),90.9%(20/22),95.24%(20/21),95.24%(20/21),100%(20/20),100%(19/19),100%(17/17)at 24 hours, 1 month, 3 months, 6 months 1 year,2 years and 3 years, respectively. Two (9.09%)patients presented with mild facial hematoma, which were completely relieved after ice compresses applied for 24 hours. No other adverse reaction was found. Conclusion C-arm or CT-guided sphenopalatine ganglion block combined with ultrasound-guided cervical paravertebral nerve block and cervical joint injection for viable SPN could relieve the pain completely, which could last for long time. It is a safe, effective, and stable mini-invasive therapy.

Key words: sphenopalatine neuralgia, sphenopalatine ganglion, nerve block, ultrasound-guided, cervical paravertebral, cervical joint