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Background and Aims Sluder’s syndrome is a rare form of sphenopalatine ganglion (SPG) neuralgia characterized by deep, unilateral facial pain, often accompanied by lacrimation and nasal congestion. SPG blocks typically offer only temporary relief. We report on the use of transnasal cryoneuromodulation as a minimally invasive method to achieve long-term pain control in a case of drug-resistant Sluder’s syndrome.Methods A 41-year-old woman with a 15-year history of continuous, pulsating, left-sided migraine (baseline NRS 3, crisis NRS 10) radiating from the fronto-orbital region and nasal ala to the zygomatic-maxillary and retroauricular areas was diagnosed with Sluder’s syndrome. A diagnostic SPG block with 2% lidocaine via the transnasal route led to complete relief (NRS 0), with symptom recurrence (NRS 4) after 15 days. After obtaining informed consent, the patient underwent fluoroscopy-guided transnasal cryoneuromodulation. A 21G cryoprobe (Cryo-S Painless®) was introduced via a silicone cannula along the superior border of the middle turbinate into the pterygopalatine fossa. Cryoablation was performed at −78°C for 4 minutes.Results Fluoroscopy, assisted by contrast medium, enabled precise identification of the pterygopalatine fossa and confirmed accurate needle placement at the SPG level ( figures 1–3). The patient experienced immediate and complete pain relief (NRS 0), maintained at 30, 60, 90, and 120 days. Mild, self-limiting epistaxis was the only adverse event.Abstract P027 Figure 1Fluoroscopic anterior-posterior view showing contrast spread within the pterygopalatine fossa, confirming accurate localization of the sphenopalatine ganglion (SPG)Abstract P027 Figure 2Fluoroscopic anteroposterior view confirming accurate placement of the cryoprobe tip within the pterygopalatine fossa, in proximity to the sphenopalatine ganglion, via the transnasal approachAbstract P027 Figure 3Lateral fluoroscopic view showing the cryoprobe advanced through the nasal cavity with the tip accurately positioned at the level of the sphenopalatine ganglion in the pterygopalatine fossaConclusions Transnasal cryoneuromodulation of the SPG is a safe, effective, and reproducible method for prolonged pain relief. Compared to the infrazygomatic ultrasound-guided approach, the transnasal technique is simpler, less invasive, and better tolerated. Moreover, the supine position used in the transnasal approach is more comfortable for the patient than the lateral decubitus required for the infrazygomatic route, supporting its role in the management of SPG-related facial pain syndromes.