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

ABSTRACT

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.