Skip to main content
Top
Published in: Acta Neurochirurgica 10/2009

01-10-2009 | Clinical Article

Microvascular decompression for glossopharyngeal neuralgia: a long-term retrospectic review of the Milan-Bologna experience in 31 consecutive cases

Authors: Paolo Ferroli, Antonio Fioravanti, Marco Schiariti, Giovanni Tringali, Angelo Franzini, Fabio Calbucci, Giovanni Broggi

Published in: Acta Neurochirurgica | Issue 10/2009

Login to get access

Abstract

Objective

To examine surgical findings and results of microvascular decompression (MVD) for glossopharyngeal neuralgia (GN).

Methods

Between 1990 and 2007, 31 consecutive patients affected by drug-resistant GN underwent MVD through a retromastoid keyhole in the supine position with the head rotated to the opposite side. A retrospective analysis was performed that paid particular attention to the relationship among surgical technique, pain control and side effects.

Results

A vascular compression of the glossopharyngeal nerve was found in all cases. Twenty-eight out of 31 patients (90.3%) were found to be pain free without medication at long-term follow-up (1–17 years, mean 7.5 years). Three patients (9.7%) were found to require medication to control pain paroxysms that were less frequent and less severe than those observed preoperatively. Two patients required repeated surgery for a drug-resistant recurrence of pain for a total of 33 MVDs. We observed no mortality and did not find any long-term surgical morbidity. Cranial nerve impairment, when observed, always resolved in the following months.

Conclusions

MVD is a safe and effective treatment for GN in patients of all ages.
Literature
1.
go back to reference Adams CB (1989) Microvascular compression: an alternative view and hypothesis. J Neurosurg 57:1–12 Adams CB (1989) Microvascular compression: an alternative view and hypothesis. J Neurosurg 57:1–12
4.
go back to reference Brock S, Scaioli V, Ferroli P, Broggi G (2004) Neurovascular decompression in trigeminal neuralgia: role of intraoperative neurophysiological monitoring in the learning period. Stereotact Funct Neurosurg 82:199–206. doi:10.1159/000082446 CrossRefPubMed Brock S, Scaioli V, Ferroli P, Broggi G (2004) Neurovascular decompression in trigeminal neuralgia: role of intraoperative neurophysiological monitoring in the learning period. Stereotact Funct Neurosurg 82:199–206. doi:10.​1159/​000082446 CrossRefPubMed
5.
go back to reference Crue BL, Carregal JA, Felsoory A (1972) Percutaneous stereotactic radiofrequency: Trigeminal tractotomy with neurophysiological recordings. Confin Neurol 34:389–397. doi:10.1159/000103087 CrossRef Crue BL, Carregal JA, Felsoory A (1972) Percutaneous stereotactic radiofrequency: Trigeminal tractotomy with neurophysiological recordings. Confin Neurol 34:389–397. doi:10.​1159/​000103087 CrossRef
6.
go back to reference Dandy WE (1927) Glossopharyngeal neuralgia (tic douloureux): Its diagnosis and treatment. Arch Surg 15:198–214 Dandy WE (1927) Glossopharyngeal neuralgia (tic douloureux): Its diagnosis and treatment. Arch Surg 15:198–214
8.
9.
go back to reference Garcia-Callejo FJ, Velert-Vila MM, Talamantes-Escriba F, Blay-Galaud L (1999) Clinical response of gabapentin for glossopharyngeal neuralgia. Rev Neurol 28(4):380–384PubMed Garcia-Callejo FJ, Velert-Vila MM, Talamantes-Escriba F, Blay-Galaud L (1999) Clinical response of gabapentin for glossopharyngeal neuralgia. Rev Neurol 28(4):380–384PubMed
10.
go back to reference Giorgi C, Broggi G (1984) Surgical treatment of glossopharyngeal neuralgia and pain from cancer of the nasopharynx. J Neurosurg 61:952–955CrossRefPubMed Giorgi C, Broggi G (1984) Surgical treatment of glossopharyngeal neuralgia and pain from cancer of the nasopharynx. J Neurosurg 61:952–955CrossRefPubMed
11.
go back to reference Headache Classification Subcommittee of the International Headache Society (2004) The International Classification of Headache Disorders. Cephalgia 24(Suppl 1):1–150 Headache Classification Subcommittee of the International Headache Society (2004) The International Classification of Headache Disorders. Cephalgia 24(Suppl 1):1–150
12.
go back to reference Hitchcock E (1970) Stereotactic trigeminal tractotomy. Ann Clin Res 2:131–135PubMed Hitchcock E (1970) Stereotactic trigeminal tractotomy. Ann Clin Res 2:131–135PubMed
13.
go back to reference Isamat F, Ferran E, Acebes JJ (1981) Selective percutaneous thermocoagulation rhizotomy in essential glossopharyngeal nevralgia. J Neurosurg 55:575–580CrossRefPubMed Isamat F, Ferran E, Acebes JJ (1981) Selective percutaneous thermocoagulation rhizotomy in essential glossopharyngeal nevralgia. J Neurosurg 55:575–580CrossRefPubMed
15.
go back to reference Jannetta PJ (1977) Observation on the aetiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia. Definitive microsurgical treatment and result in 117 patients. Neurochirurgia (Stutt) 20:145–154 Jannetta PJ (1977) Observation on the aetiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia. Definitive microsurgical treatment and result in 117 patients. Neurochirurgia (Stutt) 20:145–154
17.
go back to reference Kondo A (1998) Follow-up results of using microvascular decompression for treatment of glossopharyngeal neuralgia. J Neurosurg 88:221–225CrossRefPubMed Kondo A (1998) Follow-up results of using microvascular decompression for treatment of glossopharyngeal neuralgia. J Neurosurg 88:221–225CrossRefPubMed
18.
go back to reference Kunc Z (1965) Treatment of essential neuralgia of the 9th nerve by selective tractotomy. J Neurosurg 23:494–500CrossRefPubMed Kunc Z (1965) Treatment of essential neuralgia of the 9th nerve by selective tractotomy. J Neurosurg 23:494–500CrossRefPubMed
20.
go back to reference Lazorthes Y, Verdie JC (1974) Radiofrequency Coagulation of the Petrus Ganglion in Glossopharyngeal Neuralgia. Neurosurg 4(6):512–516CrossRef Lazorthes Y, Verdie JC (1974) Radiofrequency Coagulation of the Petrus Ganglion in Glossopharyngeal Neuralgia. Neurosurg 4(6):512–516CrossRef
21.
go back to reference Lillie H, Craig WM (1936) Anomalous vascular lesion in the cerebellopontine angle. Arch Otolaryngol 23:642–645 Lillie H, Craig WM (1936) Anomalous vascular lesion in the cerebellopontine angle. Arch Otolaryngol 23:642–645
22.
go back to reference Møller AR, Jannetta PJ (1984) Monitoring auditory nerve potentials during operations in the cerebellopontine angle. Otolaryngol Head Neck Surg 92(4):434–439PubMed Møller AR, Jannetta PJ (1984) Monitoring auditory nerve potentials during operations in the cerebellopontine angle. Otolaryngol Head Neck Surg 92(4):434–439PubMed
23.
go back to reference Olds MJ, Woods CI, Winfield JA (1995) Microvascular decompression in glossopharyngeal neuralgia. Am J Otol 16:326–330PubMed Olds MJ, Woods CI, Winfield JA (1995) Microvascular decompression in glossopharyngeal neuralgia. Am J Otol 16:326–330PubMed
25.
go back to reference Polo G, Fischer C, Sindou MP, Marneffe V (2004) Brainstem auditory evoked potential monitoring during microvascular decompression for hemifacial spasm: intraoperative brainstem auditory evoked potential changes and warning values to prevent hearing loss—prospective study in a consecutive series of 84 patients. Neurosurgery 54(1):97–104CrossRefPubMed Polo G, Fischer C, Sindou MP, Marneffe V (2004) Brainstem auditory evoked potential monitoring during microvascular decompression for hemifacial spasm: intraoperative brainstem auditory evoked potential changes and warning values to prevent hearing loss—prospective study in a consecutive series of 84 patients. Neurosurgery 54(1):97–104CrossRefPubMed
27.
go back to reference Rushton JG, Stevens JC, Miller RH (1981) Glossopharyngeal (vagoglossopharyngeal) neuralgia: A study of 217 cases. Arch Neurol 38:201–205PubMed Rushton JG, Stevens JC, Miller RH (1981) Glossopharyngeal (vagoglossopharyngeal) neuralgia: A study of 217 cases. Arch Neurol 38:201–205PubMed
29.
go back to reference Sato S, Yamada M, Koizumi H, Onozawa Y, Shimokawa N, Kawashima E, Fujii K (2009) Neurophysiological mechanisms of conduction impairment of the auditory nerve during cerebellopontine angle surgery. Clin Neurophysiol 120(2):329–335 Epub 2008 Dec 23CrossRefPubMed Sato S, Yamada M, Koizumi H, Onozawa Y, Shimokawa N, Kawashima E, Fujii K (2009) Neurophysiological mechanisms of conduction impairment of the auditory nerve during cerebellopontine angle surgery. Clin Neurophysiol 120(2):329–335 Epub 2008 Dec 23CrossRefPubMed
30.
go back to reference Sicard R, Robineau J (1920) Communications et presentations: Part I—Algie vélopharyngée essentielle: Traitement chirugical. Rev Neurol (Paris) 36:256–257 Sicard R, Robineau J (1920) Communications et presentations: Part I—Algie vélopharyngée essentielle: Traitement chirugical. Rev Neurol (Paris) 36:256–257
31.
go back to reference Sindou M, Mertens P (1993) Microsurgical vascular decompression in trigeminal and glossopharyngeal neuralgias: A 20 year experience. Acta Neurochir Suppl (Wien) 58:168–170 Sindou M, Mertens P (1993) Microsurgical vascular decompression in trigeminal and glossopharyngeal neuralgias: A 20 year experience. Acta Neurochir Suppl (Wien) 58:168–170
32.
go back to reference Stieber VW, Bourland JD, Ellis TL (2005) Glossopharyngeal neuralgia treated with gamma knife surgery: treatment outcome and failure analysis. Case report. J Neurosurg 102(Suppl):155–157CrossRefPubMed Stieber VW, Bourland JD, Ellis TL (2005) Glossopharyngeal neuralgia treated with gamma knife surgery: treatment outcome and failure analysis. Case report. J Neurosurg 102(Suppl):155–157CrossRefPubMed
34.
go back to reference Tew JM Jr, Tobler WD, Van Loveren H (1982) Percutaneous rhizotomy in the treatment of intractable facial pain. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques, vol 2. Grune and Stratton, New York, pp 1083–1106 Tew JM Jr, Tobler WD, Van Loveren H (1982) Percutaneous rhizotomy in the treatment of intractable facial pain. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques, vol 2. Grune and Stratton, New York, pp 1083–1106
38.
go back to reference White JC, Sweet WH (1969) Pain and the neurosurgeon: a 40-year experience. Charles C Thomas, Springfield, III, pp 265–302 White JC, Sweet WH (1969) Pain and the neurosurgeon: a 40-year experience. Charles C Thomas, Springfield, III, pp 265–302
Metadata
Title
Microvascular decompression for glossopharyngeal neuralgia: a long-term retrospectic review of the Milan-Bologna experience in 31 consecutive cases
Authors
Paolo Ferroli
Antonio Fioravanti
Marco Schiariti
Giovanni Tringali
Angelo Franzini
Fabio Calbucci
Giovanni Broggi
Publication date
01-10-2009
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 10/2009
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-009-0330-5

Other articles of this Issue 10/2009

Acta Neurochirurgica 10/2009 Go to the issue