Management of Recurrent Glossopharyngeal Neuralgia Following Microvascular Decompression Surgery

Palanisamy, Dhivya; Miyatani, Kyosuke; Yamada, Yoshihiko; Kawase, Tsukasa; Kato, Yōkō

doi:10.1016/j.wneu.2018.06.136

Cited by 13 publications

(11 citation statements)

References 27 publications

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“…As reported in the literature, the major causes of failed or repeated MVD for the treatment of cranial nerve vascular compression syndrome include incomplete decompression or omission of culprit vessels, regrowth of veins, elongation of vessels, Teflon compression, and arachnoidal adhesion. [8][9][10][11] In this study, regeneration of veins appeared to be one of the primary causes of recurrence after venous decompression (reported in 3 of 7 patients who underwent a reoperation). During the second operation, the regenerated vein was resected to free the nerve root, and partial rhizotomy was performed.…”

Section: Discussionmentioning

confidence: 50%

“…12,13 If the initial operation failed to provide immediate relief of pain, the cause may be due to insufficient decompression or a neglected small causative vessel. 8,10 Thorough exposure of the root entry zone is important, to obtain both surgical visualization and a wider operating space. It is imperative to keep in mind that inadequate visualization and decompression of the vessels at the brainstem surface is one of the main causes of failed and repeated MVD.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic factors for long-term outcomes of microvascular decompression in the treatment of glossopharyngeal neuralgia: a retrospective analysis of 97 patients

Zheng

Zhao

Song

et al. 2022

Journal of Neurosurgery

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OBJECTIVE The authors aimed to investigate predictors of postoperative outcomes of microvascular decompression (MVD) for the treatment of glossopharyngeal neuralgia (GPN). METHODS A cohort of 97 patients with medically refractory GPN who underwent MVD at the authors’ institution between January 2010 and July 2019 was retrospectively reviewed. Univariate and multivariate regression models were used to identify predictors of long-term outcome in patients after MVD. RESULTS Eighty-nine patients (91.8%) reported immediate and complete relief of pain after the procedure. Of the remaining 8 patients (8.2%), 6 achieved partial pain relief and pain gradually diminished within 2 weeks after surgery, and 2 did not experience postoperative pain relief. In univariate Cox regression analysis, venous compression of the glossopharyngeal nerve root entry zone (HR 3.591, 95% CI 1.660–7.767, p = 0.001) and lower degree of neurovascular conflict (HR 2.449, 95% CI 1.177–5.096, p = 0.017) were significantly associated with worse pain-free survival. In multivariate Cox regression analysis, venous compression (HR 8.192, 95% CI 2.960–22.669, p < 0.001) and lower degree of neurovascular conflict (HR 5.450, 95% CI 2.069–14.356, p = 0.001) remained independently associated with worse pain-free survival. CONCLUSIONS Venous compression of the glossopharyngeal nerve root entry zone and lower degree of neurovascular conflict were significantly correlated with shorter pain-free survival in patients who underwent MVD for GPN. Microvascular decompression is a safe, feasible, and durable approach with a low complication rate for the treatment of GPN.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Prognostic factors for long-term outcomes of microvascular decompression in the treatment of glossopharyngeal neuralgia: a retrospective analysis of 97 patients

Zheng

Zhao

Song

et al. 2022

Journal of Neurosurgery

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“…5 MVD is considered to be the first line of surgical treatment in medically refractive GPN. 6 In our case, patient had recurrent glossopharyngeal neuralgia post-tonsillectomy/trans oral styloidectomy, which got resolved completely after excising a long segment of exposed nerve along with its branches which was visible intraorally. Hence trans-oral approach was chosen for excision of nerve.…”

Section: Discussionmentioning

confidence: 62%

Glossopharyngeal neuralgia due to exposed glossopharyngeal nerve post tonsillectomy and transoral styloidectomy

Mahalingappa

Gupta

Ramakrishnan

2020

Int J Otorhinolaryngol Head Neck Surg

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<p>Glossopharyngeal neuralgia (GN) is a rare facial pain syndrome, characterized by paroxysm of excruciating radiating pain in the sensory distribution of the auricular and pharyngeal branches of glossopharyngeal and vagus nerves. In relation to the tonsil, the glossopharyngeal nerve passes deep to the styloid process and related muscles attaching to styloid process. The lingual branch of the glossopharyngeal nerve provides sensation to the posterior tongue and enters the tongue base by traveling through the constrictor muscles in the area of the lingulotonsillar sulcus. Post tonsillectomy fossa with exposed nerve causing intractable pain is a rare entity. We report a case of 64 year male patient, post tonsillectomy and transoral styloidectomy, with complaint of severe throat pain on left side for 2 years, radiating upwards to the ipsilateral ear, face and eye. Glossopharyngeal nerve and its branches were found exposed in the posterior and inferior aspect of tonsillar bed. Surgical resection of exposed glossopharyngeal nerve and its branches was carried out in view of failure to respond to oral carbamazepine. Patient was symptom free during 10 months of follow up visit. GN is a rare condition following tonsillectomy and styloidectomy. Radical dissection of tonsillar bed during tonsillectomy and not suturing tonsillar bed properly after styloidectomy can lead to exposure of glossopharyngeal nerve and its branches, resulting in intractable GN.</p>

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“…Idiopathic TN indicates that no neurological cause can be found ( 4 ). The incidence of GPN is approximately 1/100th that of TN ( 5 ). GPN is divided into idiopathic and secondary types.…”

Section: Discussionmentioning

confidence: 99%

Case report: Trigeminal neuralgia misdiagnosed as glossopharyngeal neuralgia

Xiong

Huang

et al. 2023

Front. Neurol.

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BackgroundTrigeminal neuralgia (TN) and glossopharyngeal neuralgia (GPN) are cranial nerve neuralgias with the same clinical manifestations, pathological features, and trigger factors; their affected sites are adjacent. Performing a magnetic resonance imaging (MRI) examination alone can easily lead to a misdiagnosis.Case presentationA 72-year-old man had visited another hospital with severe left-sided tongue pain. On MRI, vascular compression of the glossopharyngeal nerve had been visible, with unclear evidence of trigeminal nerve involvement. He had been diagnosed with left-sided GPN and underwent microvascular decompression (MVD) of the left glossopharyngeal nerve. However, no improvement was observed after surgery. During a second surgery at our hospital, MVD of the trigeminal nerve was performed, and the trigeminal nerve was fully explored and separated. The patient's pain resolved after surgery. Ultimately, the patient was definitively diagnosed with left-sided TN.Discussion and conclusionMVD is currently the most efficacious surgical option for treating cranial nerve neuralgia. To select patients for MVD, having an MRI criteria for identifying true neurovascular compression will be helpful. However, clinicians should focus more on a patient's clinical symptoms and not rely solely on MRI findings. This patient's case can help clinicians distinguish between TN and GPN, improve the understanding of these diseases, avoid misdiagnosis, and reduce the possibility of secondary damage.

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Management of Recurrent Glossopharyngeal Neuralgia Following Microvascular Decompression Surgery

Cited by 13 publications

References 27 publications

Prognostic factors for long-term outcomes of microvascular decompression in the treatment of glossopharyngeal neuralgia: a retrospective analysis of 97 patients

Prognostic factors for long-term outcomes of microvascular decompression in the treatment of glossopharyngeal neuralgia: a retrospective analysis of 97 patients

Glossopharyngeal neuralgia due to exposed glossopharyngeal nerve post tonsillectomy and transoral styloidectomy

Case report: Trigeminal neuralgia misdiagnosed as glossopharyngeal neuralgia

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