Neuralgia del glosofaríngeo izquierdo: una patología poco frecuente. Un reporte de caso

La neuralgia del glosofaríngeo es una patología rara donde hay dolor agudo y punzante en la fosa amigdalina, ángulo de la mandíbula y base de la lengua. Su principal causa es la compresión neurovascular la cual se puede diagnosticar con una resonancia cerebral. Su manejo es médico, principalmente; con fármacos, especialmente, carbamazepina y oxcarbazepina; y si no hay respuesta, va a cirugía mediante descompresión microvascular e interposición de material blando (politetrafluoroetileno), con o sin transección del IX par craneal. Se presenta el caso de una mujer de 64 años, hipertensa controlada, con dolor característico, que con 5 fármacos antineuropáticos y 1 derivado de opioides no cedía el dolor. La resonancia cerebral con secuencia FIESTA muestra una compresión neurovascular del IX PC con la PICA izquierda. Se le realiza descompresión microvascular del IX PC, con resolución de la sintomatología y sin recurrencia, saliendo de alta pronto. Se concluye que el manejo quirúrgico de esta patología en casos refractarios al tratamiento médico es una opción con buenas tasas de éxito y baja morbilidad.

Glossopharyngeal neuralgia is a rare pathology, with a sharp and stabbing pain in the tonsillar fossa, angle of the jaw and base of the tongue. Its main etiology is neurovascular compression, which can be diagnosed with a brain MRI. Its management is mainly medical with drug, especially carbamazepine and oxcarbazepine, and if there is no response, surgery is performed through microvascular decompression and interposition of soft material (polytetrafluoroethylene) with or without transection of IX cranial nerve. We present the case of a 64-year-old woman, with controlled hypertension, with classic pain, who did not relieve pain with 5 antineuropathic drugs and 1 opioid derivative. Brain MRI with FIESTA sequence shows a neurovascular compression of the glossopharyngeal nerve with the left PICA. Microvascular decompression of the glossopharyngeal nerve was performed, with resolution of the symptoms and without recurrence, and she was discharged soon. We concluded that the surgical management of this pathology in refractory cases to medical treatment is an option with good success rates and low morbidity.

Neuralgia del nervio glosofaríngeo posamigdalectomía: reporte de dos casos / Post-tonsillectomy glossopharyngeal nerve neuralgia: report of two cases

Resumen La amigdalectomía es uno de los procedimientos quirúrgicos más frecuentes que realiza el otorrinolaringólogo. Dentro de las complicaciones posoperatorias, la neuralgia del nervio glosofaríngeo es extremadamente poco frecuente. En este artículo se presentan dos casos clínicos pediátricos con neuralgia del glosofaríngeo posamigdalectomía que fueron resueltos con tratamiento médico.

Abstract Tonsillectomy is one of the most common procedures done by the otolaryngologist. Among post-operative complications, the glossopharyngeal neuralgia is extremely uncommon. This article presents two pediatric clinical cases with post-tonsillectomy glossopharyngeal neuralgia that were resolved with medical treatment.

Microvascular decompression for glossopharyngeal neuralgia with posterior inferior cerebellar artery as offending artery / 中国脑血管病杂志

Objective To investigate the key technical points of microvascular decompression (MVD)for the treatment of primary glossopharyngeal neuralgia (GPN)and its efficacy. Methods From July 2011 to October 2016,18 consecutive patients with primary GPN treated with MVD at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. All patients received magnetic resonance angiography (MRA)examination before procedure. The anatomical relationship between glossopharyngeal nerve / vagus nerve and peripheral blood vessels were identified. Seventeen of them were treated via suboccipital retrosigmoid approach,one were treated via far lateral approach. None of the patients were treated with nerve root rhizotomy. Results Eighteen patients had paroxysmal severe pain in tongue,pharynx,tonsil or deep ear canal and other parts before procedure. Preoperative MRA indicated and confirmed in the surgery that the offending vessels were the trunks or their branches of the posterior inferior cerebellar artery in this group of patients. During the operation,the offending vessels were removed from the out brainstem areas of the glossopharyngeal nerves and vagus nerves under the direct vision in order to ensure that the blood vessels and nerves no longer contacted with each other. There were no complications, such as disability and death,cerebrospinal fluid leakage,and intracranial infection. All the patients were followed up after procedure;the mean follow-up period was 1-62 months. The symptom of pain disappeared completely in 17 of them. The Numberical Rating Scale (NRS)score for pain were 0. The pain in one patient was not relieved. The NRS score was 8 at discharge;it was the same as before procedure. Three patients had mild hoarseness,throat discomfort after procedure. They were relieved gradually in the follow-up period. Conclusion MVD is a safe and effective method for the treatment of GPN. Posterior inferior cerebellar artery is the most common offending artery. Preoperative imaging examination and clear decompression during the procedure are very important. The cutting off of glossopharyngeal nerves and vagus nerves needs to be handled with care.

Microvascular Decompression for Glossopharyngeal Neuralgia: Clinical Analyses of 30 Cases

OBJECTIVE: We present our experience of microvascular decompression (MVD) for glossopharyngeal neuralgia (GPN) and evaluate the postoperative outcomes in accordance with four different operative techniques during MVD. METHODS: In total, 30 patients with intractable primary typical GPN who underwent MVD without rhizotomy and were followed for more than 2 years were included in the analysis. Each MVD was performed using one of four different surgical techniques: interposition of Teflon pieces, transposition of offending vessels using Teflon pieces, transposition of offending vessels using a fibrin-glue-coated Teflon sling, and removal of offending veins. RESULTS: The posterior inferior cerebellar artery was responsible for neurovascular compression in 27 of 30 (90%) patients, either by itself or in combination with other vessels. The location of compression on the glossopharyngeal nerve varied; the root entry zone (REZ) only (63.3%) was most common, followed by both the REZ and distal portion (26.7%) and the distal portion alone (10.0%). In terms of detailed surgical techniques during MVD, the offending vessels were transposed in 24 (80%) patients, either using additional insulation, offered by Teflon pieces (15 patients), or using a fibrin glue-coated Teflon sling (9 patients). Simple insertion of Teflon pieces and removal of a small vein were also performed in five and one patient, respectively. During the 2 years following MVD, 29 of 30 (96.7%) patients were asymptomatic or experienced only occasional pain that did not require medication. Temporary hemodynamic instability occurred in two patients during MVD, and seven patients experienced transient postoperative complications. Neither persistent morbidity nor mortality was reported. CONCLUSION: This study demonstrates that MVD without rhizotomy is a safe and effective treatment option for GPN.

Efficacy of radiofrequency thermocoagulation guided by three-dimensional computer tomography for treatment of severe recurrent glossopharyngeal neuralgia / 中华麻醉学杂志

Objective To evaluate the efficacy of radiofrequency thermocoagulation guided by three-dimensional computer tomography(3-D CT)for the treatment of severe recurrent glossopharyngeal neuralgia(GPN). Methods Twenty-nine patients of both sexes with recurrent intractable GPN, aged 42-75 yr, with recurrent course of 1-8 yr, of Barrow Neurological Institute(BNI)Pain Scale(BNI-P) class Ⅳ or Ⅴ, were enrolled in this study. Percutaneous radiofrequency thermocoagulation was applied to the middle and lower segment of the styloid process of the glossopharyngeal nerve under 3D CT guidance. Before operation and at 72 h, 6 months and 1 year after operation, BNI-P class and BNI Numbness Scale scores were recorded, and effective treatment and operation-related complications were also recorded. Re-sults Nineteen patients underwent one operation, 8 patients underwent two operations, and 2 patients un-derwent three operations. BNI-P class was significantly lower at each time point after operation than before operation(P<0.05). The rate of effective treatment was 100% at 72 h and 6 months after operation and 97% at 1 yr after operation. Different degrees of dysesthesias at the posterior part of the tongue on the affect-ed side occurred after operation and disappeared at 1 yr after operation. Operation-related nausea and vomi-ting, facial nerve damage, accessory nerve damage and fatality were not observed. Conclusion 3D CT-guided radiofrequency thermocoagulation of the glossopharyngeal nerve provides reliable efficacy and higher safety for the patients with severe recurrent GPN.

The observation of efficacy of medical ozone in treatment of glossopharyngeal neuralgia / 中国基层医药

Objective To observe the clinical effect of glossopharyngeal neuralgia with Medical Ozone. Methods 60 cases with glossophaiyngeal neuralgia were divided into two groups randomly,treatment group applied for glossopharyngeal neuralgia block with Medical Ozone and medicine,control group only applied for glossopharyngeal neuralgia block and medicine. Results At 7th and 14th day after treatment,visual analogue scale was lower in treatment group compared with control group(P <0.01) ,at 14th day after treatment,the total effective rate was higher in treatment group compared with control group (P < 0.05). Conclusion The clinical cure rate of glossopharyngeal neuralgia with Medical Ozone was high and it had popularization value.

Glossopharyngeal neuralgia:MR findings / 中华放射学杂志

Objective To investigate the possibility of MRI on visualizing the relationship between glossopharyngeal nerve and surrounding vessels,and to evaluate the significance of MRI in the diagnosis and treatment of glossopharyngeal neuralgia.Methods MRI findings were analyzed retrospectively in 12 patients with glossopharyngeal neuralgia,and were compared with surgical findings and effect of pain relief.Results The artery compression or contact of the glossopharyngeal entry zone,as revealed during operation in l0 patients with glossopharyngeal neuralgia,was visualized on MRI in 9 and not seen in 1.The venous compression of the glossopharyngeal entry zone was not identified on MRI in 1.The conglutinative arachnoids of the glossopharyngeal entry zone was not visualized on MRI in 1.MRI demonstrated the affected glossopharyngeal nerve root entry zone was compressed or contacted by the posterior inferior cerebellar artery (PICA)in 8 patients and by the vertebral artery in 1 patient.One patient's offending vessel was confirmed to be the anterior inferior cerebellar artery(AICA)by the operation,and the surgical findings were corresponded with MRI in others.Vascular compression or contact of the affected glossopharyngeal nerve was not visualized on MRI in 3 patients,and operation confirmed that the glossopharyngeal nerve root entry zone was compressed by unknown artery in 1,by small vein in 1,and by eonglutinative araehnoids in 1, respectively.Eight patients presented with symptoms of the ipsilateral trigeminal neuralgia concurrently.The compression of the affected trigeminal nerve root by superior cerebellar artery(SCA)was visualized on MRI in 6 patients,and operation did not reveal the source of artery compression in 1 and corresponded with MRI findings in other 5 cases.Vascular compression of affected trigeminal nerve was not visualized on MRI in 2 patients,and intraoperative inspection revealed that trigeminal nerve root was compressed by draining vein of brainstem in 1 and not compressed by any vessels in 1.All patient's neuralgia resolved after microvascular decompression of glossopharyngeal nerve and trigeminal nerve.Conclusion It is possible to visualize the glossopharyngeal and surrounding arteries on MRI,and it is of great significance in the diagnosis and treatment of this kind of glossopharyngeal neuralgia.