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Vago-glossopharyngeal neuralgia: a literature review of neurosurgical experience

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Abstract

Glossopharyngeal neuralgia (GPN), or better named vago-glossopharyngeal neuralgia (VGPN), is a rare disorder amounting to 1 % of the incidence of trigeminal neuralgia (TN). Pain is paroxysmal, of the electrical shooting type, and mainly provoked by stimulation of the pharynx or deep throat, especially during swallowing. Due to its rarity, VGPN is often misdiagnosed. The front line of medical treatment is based on anticonvulsants. Surgery should be considered when the pain is refractory to medications. In most patients, the cause is neurovascular conflict on root entry zone (REZ) or midcistern portion, of the IXth and/or Xth cranial nerves. Compressive vessels can be evidenced by means of a high sensibility and a high specificity resolution MR imaging in most centers. Present consensus is that the first option of neurosurgical treatment be microvascular decompression. In patients with precarious general conditions, stereotactic radiosurgery may be considered. Also, thermo-rhizotomy at the pars nervosa of foramen jugularis or tractotomy-nucleotomy at brainstem may be alternatives, but these methods entail a significant risk of deficits. In this article, the authors reviewed the main literature series on neurosurgical treatments of this disease.

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  1. Department of Neurosurgery, Hopital Renji, University of Jiaotong Shanghai, Building 7, 160 Pujian Road, 200127, Shanghai, China

    Jianqing Chen

  2. Department of Neurosurgery A, Hopital neurologique Pierre Wertheimer, University of Lyon I, GHE, 59, Boulevard Pinel, 69003, Lyon, France

    Marc Sindou

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Vago-glossopharyngeal neuralgia is a disabling disease featured by sharp, stabbing, and severe painful attacks affecting the ear, tongue, tonsillar fossa, or beneath the angle of the jaw. Attacks are stereotyped in the individual patient and precipitated by swallowing, chewing, talking, coughing, and/or yawning. Pain can also be associated with hemodynamic instability resulting from reflexive autonomic outflow that can eventually lead to life-threatening syncopal episodes. It may remit and relapse like trigeminal neuralgia with which it is often confused. Following Dandy’s seminal article on the subject [1] published in 1927, the surgical treatment of glossopharyngeal neuralgia has consisted of sectioning the glossopharyngeal nerve proximal to its entrance into the jugular foramen. Fifty years later, Laha and Jannetta [2] advocated microvascular decompression (MVD) for the treatment of this disease. Long-term follow-up studies of MVD demonstrated sustained relief of pain in the majority of patients. Percutaneous thermorhizotomy has been used to treat a limited number of cases with promising results [3]. Radiosurgery is increasingly gaining a role in the treatment of this disabling disease, at least in a subgroup of patients with contraindication for open surgery and should be considered as the alternative treatment to MVD for the satisfactory results and negligible complication rates. This is a concise review article summarizing literature on the treatment of glossopharyngeal neuralgia. The literature is thoroughly reviewed and commented by recognized experts in the field.

Alfredo Conti

Messina, Italy

1. Dandy W (1927) Glossopharyngeal neuralgia (tic douloureux): its diagnosis and treatment. Arch Surg 15:198–214.

2. Laha RK, Jannetta PJ (1977) Glossopharyngeal neuralgia. J Neurosurg 47:316–20.

3. Giorgi C, Broggi G (1984) Surgical treatment of glossopharyngeal neuralgia and pain from cancer of the nasopharynx. J Neurosurg 61:952–55.

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Chen, J., Sindou, M. Vago-glossopharyngeal neuralgia: a literature review of neurosurgical experience. Acta Neurochir 157, 311–321 (2015). https://doi.org/10.1007/s00701-014-2302-7

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