Microvascular decompression for glossopharyngeal neuralgia: a retrospective analysis of 228 cases

Xia, Lei; Li, Yongsheng; Liu, Mingxing; Zhong, Jun; Dou, Ning-Ning; Li, Bin; Li, Shiting

doi:10.1007/s00701-017-3347-1

Cited by 23 publications

(15 citation statements)

References 47 publications

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“…Microvascular decompression (MVD) is a well-established treatment for NVCS 150 . High effective rates and good clinical outcomes have been reported with MVD in patients with these diseases above 120 , 126 , 148 , 151 .…”

Section: Neurovascular Compression Syndromementioning

confidence: 98%

“…GPN is characterized by a sudden onset of lancinating pain in the posterior pharynx, base of tongue, tonsillar region, or deep ear, that is, the sensory distribution of the auricular and pharyngeal branches of the CN IX, with an incidence of 0.7/100 000 per year 120 , 121 . The PICA is the primary culprit artery of GPN due to its close relationship with CN IX.…”

Section: Neurovascular Compression Syndromementioning

confidence: 99%

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Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature

Miao¹,

Zhang²,

Wang³

et al. 2020

Int. J. Med. Sci.

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The posterior inferior cerebellar artery (PICA), with its unique anatomical complexity, is of great clinical importance and involved in many diseases including aneurysm, ischemic stroke, neurovascular compression syndrome (NVCS), arteriovenous malformation (AVM), and brain tumor. However, a comprehensive systematic review of the importance of the PICA is currently lacking. In this study, we perform a literature review of PICA by searching all the associated papers in the PUBMED database hoping to provide a better understanding of the artery. The PICA has tortuous and variable course and territory, divided into 5 segments. Various aneurysms involving PICA were not uncommon, of which the treatment is challenging. The PICA infarct typically manifests lateral medullary syndrome (LMS) and is more likely to cause mass effects. The PICA frequently compresses the medulla and the cranial nerves resulting in various neurovascular compression syndromes (NVCS). Arteriovenous malformation (AVM) fed by PICA are associated with aneurysm and dissection which have high risk of rupture and worse outcome. PICA injured by head trauma can cause fatal SAH. VA terminating in PICA probably cause Bow hunter's syndrome (BHS). The PICA supplies many brain tumors and can be used in intracerebellar chemotherapy. The PICA can be exposed and injured during surgeries especially in telovelar approach, and it also plays an important role in bypass surgeries, hinting the surgical importance of PICA. In conclusion, PICA is very important in clinical practice.

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Section: Neurovascular Compression Syndromementioning

confidence: 98%

Section: Neurovascular Compression Syndromementioning

confidence: 99%

Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature

Miao¹,

Zhang²,

Wang³

et al. 2020

Int. J. Med. Sci.

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“…Surgical treatment by microvascular decompression should be considered the gold standard of treatment (37); further options include radiofrequency ablation and radiosurgery (38). The reported success rate of microvascular decompression is over 90% (34,39,40).…”

Section: Glossopharyngeal Neuralgia (Vago-glossopharyngeal Neuralgia)mentioning

confidence: 99%

Nerve Compression Syndromes in the Posterior Cranial Fossa

Baldauf¹,

Rosenstengel²,

Schroeder³

2019

Deutsches Ärzteblatt International

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Background: Nerve compression syndromes in the posterior cranial fossa can severely impair patients' quality of life. There is often uncertainty about the best treatment. In this article, we provide an overview of these conditions and the corresponding treatment strategies. Methods: This review is based on pertinent publications retrieved by a selective search in PubMed and on a scientific analysis of the authors' patient collective. Results: These syndromes are caused by compression of a cranial nerve by an artery or vein at the zone of the nerve's entry to or exit from the brainstem. The best-known neurovascular compression syndrome is trigeminal neuralgia, followed by hemifacial spasm. Less well known are glossopharyngeal neuralgia, nervus intermedius neuralgia, and vestibular paroxysmia. The initial treatment of trigeminal neuralgia is medical: the first line of treatment is with sodium-blocking anticonvulsants, such as carbamazepine. For patients with hemifacial spasm, botulinum toxin injection is the recommended initial treatment and often leads to a satisfactory regression of the spasms. If these treatments fail, a microvascular decompression operation is indicated. The aim of the procedure is to separate the irritating vessel from the nerve and to keep these structures apart permanently. There is hardly any available evidence on these treatment strategies from randomized controlled trials. Conclusion: Nerve compression syndromes in the posterior cranial fossa can generally be treated nonsurgically at first. Over the course of the condition, however, treatment failure or intolerable side effects may arise. In such cases, a microvascular decompression operation is indicated. This is a causally directed form of treatment that generally yields very good results.

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“…In a 2018 systematic review and meta-analysis of 446 cases, 90% had complete long-term pain relief a median of 56 months after MVD, with a complication rate of 21% [20]. In another recent large series, Xia et al [21] reported a 92.5% 5-year rate of adequate pain relief, with a complication rate of 16.2%. Recurrence in these studies ranged from 3.7 to 7% [21, 22].…”

Section: Discussionmentioning

confidence: 99%

“…In another recent large series, Xia et al [21] reported a 92.5% 5-year rate of adequate pain relief, with a complication rate of 16.2%. Recurrence in these studies ranged from 3.7 to 7% [21, 22]. For NS, Lu et al [20] reported a long-term pain relief rate of 96% at a median follow-up duration of 33 months, with a complication rate of 15%.…”

Section: Discussionmentioning

confidence: 99%

Repeat Gamma Knife Radiosurgery for Recurrent Glossopharyngeal Neuralgia: A Systematic Review and Our Initial Experience

Kaye

Daggubati

Zeller

et al. 2020

Stereotact Funct Neurosurg

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Background: Glossopharyngeal neuralgia (GPN) is a rare facial pain syndrome with debilitating symptoms. For medication-resistant GPN, stereotactic radiosurgery (SRS) is an emerging treatment option with a promising role; however, recurrence rates after SRS are fairly high. We present a patient who underwent repeat SRS for recurrent GPN and subsequently maintained over 3 years of complete pain relief. For the first time, we present a systematic review of repeat SRS for recurrent GPN. Summary: Twelve cases of repeat SRS for GPN have previously been reported in the literature (13 studies including ours). Among patients with follow-up, initial pain relief was achieved in 83% (n = 10) of cases a median of 5 weeks after repeat SRS; 2 patients failed to obtain any pain relief. A favorable pain response (BNI I-IIIb) was achieved in 67 and 58% of cases at 6 and 12 months, respectively. All 13 were targeted to the glossopharyngeal meatus. Three patients (23%) experienced adverse radiation effects. Five patients (50%) experienced recurrence a median of 14 months after repeat SRS. Two patients (17%) required additional surgical intervention. At the final follow-up, 75% (n = 9) of the patients had a favorable pain outcome. Key Messages: Repeat SRS may be a viable alternative to open surgery for the treatment of recurrent GPN, albeit with an increased risk of adverse radiation effects. Though limited by a small cohort of patients, the best predictors of an effective second treatment may be a response to initial SRS for > 5 months, a maximum dose > 75 Gy, and a target at the glossopharyngeal meatus. Larger prospective studies are needed to better define its role.

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Microvascular decompression for glossopharyngeal neuralgia: a retrospective analysis of 228 cases

Abstract: This investigation demonstrated that MVD is a safe and effective remedy for treatment of GPN.

Cited by 23 publications

References 47 publications

Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature

Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature

Nerve Compression Syndromes in the Posterior Cranial Fossa

Repeat Gamma Knife Radiosurgery for Recurrent Glossopharyngeal Neuralgia: A Systematic Review and Our Initial Experience

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