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

Abstract

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.

Stereotactic radiosurgery for idiopathic glossopharyngeal neuralgia: A systematic review

“…1 ). We identified 19 studies 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 between 2005 and 2023 ( Table 2 ). Three 14 ; 17 ; 31 studies were also part of another multicentre analysis 15 so their data was not included in the final analysis.…”

Long‐term outcomes of Gamma Knife radiosurgery in treating glossopharyngeal neuralgia

“…Literature on repeat GKRS is scarce, but available studies show about 83% of patients get relief after a median of 5 weeks following a second GKRS, with 67% and 58% of cases achieved a satisfactory response (BNI grade I-IIIb) at 6 and 12 months post-treatment, respectively. 24 Adverse events were noticed in three patients (23%), and recurrence occurred in five patients (50%) at a median of 14 months after the repeat GKRS. Balossier et al 23 noted similar times to pain relief after the second and third GKRS sessions, with no side effects reported after the third treatment, suggesting safety and effectiveness for resistant GPN when MVD is not an option.…”

“…Considering that the recurrence of symptoms after an initial improvement is not uncommon in GKRS for GPN, individuals considering GKRS for GPN should be informed that they might require additional GKRS sessions. Literature on repeat GKRS is scarce, but available studies show about 83% of patients get relief after a median of 5 weeks following a second GKRS, with 67% and 58% of cases achieved a satisfactory response (BNI grade I–IIIb) at 6 and 12 months post‐treatment, respectively 24 . Adverse events were noticed in three patients (23%), and recurrence occurred in five patients (50%) at a median of 14 months after the repeat GKRS.…”

“…Given the relative rarity of the diagnosis and widespread use of surgical treatment, large series on the GKRS treatment of GPN have been limited, and the present study has one of the largest radiosurgery cohorts demonstrating the efficacy and safety of GKRS (Table 2). [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Surgery is considered for GPN when conservative medical approaches fail or cause severe side effects. Open surgical procedures, such as MVD and rhizotomy, are extensively documented in GPN literature, and MVD is the preferred surgical option despite risks such as cranial nerve deficits and cerebrospinal fluid leaks.…”

“…Given the relative rarity of the diagnosis and widespread use of surgical treatment, large series on the GKRS treatment of GPN have been limited, and the present study has one of the largest radiosurgery cohorts demonstrating the efficacy and safety of GKRS (Table 2). 10–27 …”