Microvascular Decompression in the Management of Glossopharyngeal Neuralgia: Analysis of 217 Cases

Patel, Atul T.; Kassam, Amin; Horowitz, Michael; Chang, Yue‐Fang

doi:10.1097/00006123-200204000-00004

Cited by 165 publications

(103 citation statements)

References 13 publications

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“…Surgical outcomes and patient satisfaction rates may be best in typical GPN patients with pain restricted to the throat and Balloon Test Occlusion for GPN palate. 13) Our patient suffered atypical pain radiating to the face and ear, and application of xylocaine to the pharynx was partially effective. Balloon test occlusion may facilitate the prediction of surgical effectiveness in such atypical GPN patients.…”

Section: Discussionmentioning

confidence: 74%

“…7,8,13,14) Complete pain relief was obtained in about 80% of patients treated by MVD in large series, but a few patients suffered partial recurrence during longterm follow up, 13,14) and the causes of treatment failure remained unclear. Reduction of the failure rate requires identification of the factors that may compromise the surgical results.…”

Section: Discussionmentioning

confidence: 99%

“…9) Medical treatment with agents such as carbamazepine remains the first choice in patients with GPN, 15) but may gradually become ineffective, so many patients undergo surgery. Microvascular decompression (MVD) achieves good results in patients with a diagnosis of vascular compression syndrome, 7,8,13,14) but a definitive diagnosis is necessary for the selection of MVD surgery as the optimum treatment for GPN.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of Balloon Test Occlusion in the Diagnosis of Glossopharyngeal Neuralgia -Case Report-

Hasegawa

Morioka

Kai

et al. 2008

Neurol. Med. Chir.(Tokyo)

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A 67-year-old man presented with glossopharyngeal neuralgia (GPN) manifesting as severe paroxysmal pharyngeal and retroauricular pain not controlled by medical treatment. Constructive interference in steady state magnetic resonance imaging suggested that the responsible vessel was the right vertebral artery (VA). As carbamazepine had some limited effect, we reviewed the appropriateness of microvascular decompression surgery. Balloon test occlusion of the VA was performed to confirm that the GPN was due to right VA pulsation. The neuralgia disappeared and reappeared with balloon inflation and deflation. Therefore, the VA was moved to decompress the glossopharyngeal nerve. The patient was pain-free after surgery. Balloon test occlusion may be useful in the diagnosis of GPN and the selection of the most appropriate surgical treatment.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Usefulness of Balloon Test Occlusion in the Diagnosis of Glossopharyngeal Neuralgia -Case Report-

Hasegawa

Morioka

Kai

et al. 2008

Neurol. Med. Chir.(Tokyo)

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“…Postoperative hemorrhage is one of the most dangerous complications following MVD and usually results in significant morbidity and mortality. Postoperative hemorrhage usually occurs within the first few hours after operation, although the incidence is only 0 to 1%, [2][3][4][5][6] and delayed hemorrhage is extremely rare. Acute postoperative hemorrhage is mainly attributed to inadequate intraoperative hemostasis, whereas delayed hemorrhage has several possible mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Delayed Hemorrhage Following Microvascular Decompression-Three Case Reports-

Zhao

et al. 2007

Neurol. Med. Chir.(Tokyo)

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Postoperative hemorrhage is one of the most dangerous complications following microvascular decompression (MVD), and usually occurs within the first 24 hours after MVD operation, whereas delayed hemorrhage is extremely rare. The possible mechanisms of acute and delayed postoperative hemorrhage following MVD seem to be different. Three of 685 patients treated by MVD developed delayed hematoma more than 24 hours after surgery, including two cases at the operative site and one at a remote site. The possible causes of such delayed hemorrhage are discussed. Postoperative monitoring is extremely important after the MVD procedure. If any hemorrhage can be identified at the early stage, valuable time can be won for treatment and better outcome.

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“…21,24,25,27 Because of the proximity of the cranial nerve VIII to cranial nerves decompressed during the procedure, the auditory nerve in many patients is often stretched or damaged, resulting in hearing impairment. Although sensorineural hearing loss after MVD is frequently documented and well understood, high-frequency hearing loss (HFHL) is currently not well recognized.…”

mentioning

confidence: 99%

The incidence of high-frequency hearing loss after microvascular decompression for trigeminal neuralgia, glossopharyngeal neuralgia, or geniculate neuralgia

Meigh

Dasyam²,

Shankar³

et al. 2015

JNS

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S enSorineural hearing loss after microvascular decompression (MVD) has a reported incidence of 1%-23.8% when performed for trigeminal neuralgia (TGN), 1.5%-4.2% for glossopharyngeal neuralgia (GPN), and 22% for geniculate neuralgia (GN). 21,24,25,27 Because of the proximity of the cranial nerve VIII to cranial nerves decompressed during the procedure, the auditory nerve in many patients is often stretched or damaged, resulting in hearing impairment. Although sensorineural hearing loss after MVD is frequently documented and well understood, high-frequency hearing loss (HFHL) is currently not well recognized. HFHL has been recently reported after MVD for hemifacial spasm (HFS). . disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect The primary aim of this study was to evaluate the incidence and discuss the pathogenesis of high-frequency hearing loss (HFHL) after microvascular decompression (MVD) for trigeminal neuralgia (TGN), glossopharyngeal neuralgia (GPN), or geniculate neuralgia (GN). methods The authors analyzed preoperative and postoperative audiogram data and brainstem auditory evoked potentials (BAEPs) from 93 patients with TGN, 6 patients with GPN, and 8 patients with GN who underwent MVD. Differences in pure tone audiometry > 10 dB at frequencies of 0.25, 0.5, 1, 2, 4, and 8 kHz were calculated preoperatively and postoperatively for both the ipsilateral and the contralateral sides. Intraoperative monitoring records were analyzed and compared with the incidence of HFHL, which was defined as a change in pure tone audiometry > 10 dB at frequencies of 4 and 8 kHz. results The incidence of HFHL was 30.84% on the side ipsilateral to the surgery and 20.56% on the contralateral side. Of the 47 patients with HFHL, 20 had conductive hearing loss, and 2 experienced nonserviceable hearing loss after the surgery. The incidences of HFHL on the ipsilateral side at 4 and 8 kHz were 17.76% and 25.23%, respectively, and 8.41% and 15.89%, respectively, on the contralateral side. As the audiometric frequency increased, the number of patients with hearing loss increased. No significant postoperative difference was found between patients with and without HFHL in intraoperative BAEP waveforms. Sex, age, and affected side were not associated with an increase in the incidence of hearing loss. coNclusioNs High-frequency hearing loss occurred after MVD for TGN, GPN, or GN, and the greatest incidence occurred on the ipsilateral side. This hearing loss may be a result of drill-induced noise and/or transient loss of cerebrospinal fluid during the course of the procedure. Changes in intraoperative BAEP waveforms were not useful in predicting HFHL after MVD. Repeated postoperative audiological examinations may be useful in assessing the prognosis of HFHL.

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Microvascular Decompression in the Management of Glossopharyngeal Neuralgia: Analysis of 217 Cases

Abstract: MVD is a safe, effective form of therapy for GPN. It may be most beneficial for patients with typical GPN, especially when symptoms are restricted to deep throat pain only.

Cited by 165 publications

References 13 publications

Usefulness of Balloon Test Occlusion in the Diagnosis of Glossopharyngeal Neuralgia -Case Report-

Usefulness of Balloon Test Occlusion in the Diagnosis of Glossopharyngeal Neuralgia -Case Report-

Delayed Hemorrhage Following Microvascular Decompression-Three Case Reports-

The incidence of high-frequency hearing loss after microvascular decompression for trigeminal neuralgia, glossopharyngeal neuralgia, or geniculate neuralgia

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