Percutaneous radiofrequency neurolysis guided by computed tomography for the treatment of glossopharyngeal neuralgia

Eagle’s Syndrome Managed Successfully by Pulsed Radiofrequency Treatment

Eagle’s syndrome is a rare cause of craniofacial pain caused by impingement of adjacent neurovascular elements by an elongated styloid process or by a calcified stylohyoid ligament. There is a wide spectrum of clinical presentations, which encompasses craniofacial pain, oropharyngeal pain, otalgia, headache, and vertigo. Typically, the glossopharyngeal nerve gets entrapped, giving rise to characteristic orofacial pain. The diagnosis of Eagle’s syndrome is confirmed radiologically, and the management includes pharmacotherapy and surgical removal of the styloid process. Moreover, minimally invasive interventions in the form of glossopharyngeal nerve block and radiofrequency treatment can also be effective in providing pain relief. We report a case of an elderly male who presented with features of glossopharyngeal neuralgia secondary to an elongated styloid process and was managed successfully with pulsed radiofrequency treatment of the glossopharyngeal nerve.

Continuous radiofrequency thermocoagulation under CT-guidance for glossopharyngeal neuralgia: Two case reports

RATIONALE

Glosssopharyngeal neuralgia (GPN) is a painful syndrome characterized by paroxysmal neuropathic pain in the pharynx, tonsil, posterior base of tongue, inner ear, and mandibular angle. The traditional therapies of GPN, including medication and surgical operation, are not always effective in pain controlling. Radiofrequency therapy is a minimally interventional technique to provide analgesia in chronic pain.

PATIENT CONCERNS

Two patients who were refractory to medical treatment were hospitalized for primary GPN.

DIAGNOSES

Two patients were diagnosed by symptoms, physical signs and imaging examination.

INTERVENTIONS

The first patient underwent pulsed radiofrequency of the glossopharyngeal nerve under CT-guidance as a preferred method. The pulsed radiofrequency (PRF) was performed at 42°C for 10 minutes with a pulsed frequency of 2 Hz and a pulse width 20 ms. There is no symptom improvement after PRF procedure. Three days later, continuous radiofrequency (CRF) thermocoagulation was performed. The pain disappeared after CRF within 36 months followed-up. CRF thermocoagulation under CT-guidance was accepted by the second patient as the first choice.

OUTCOMES

An overall reduction of pain was reported after the procedure and telephone consult for 24-months follow-up confirmed the persistence of the pain relief.

LESSONS

The CRF thermocoagulation produced no complications or side effects in the two cases, and was proved effective in the treatment of GPN.

Microvascular decompression for glossopharyngeal neuralgia through a microasterional approach: A case series

Background:

Glossopharyngeal neuralgia (GPN) is an uncommon craniofacial pain syndrome. It is characterized by a sudden onset lancinating pain usually localized in the sensory distribution of the IX cranial nerve associated with excessive vagal outflow, which leads to bradycardia, hypotension, syncope, or cardiac arrest. This study aims to review our surgical experience performing microvascular decompression (MVD) in patients with GPN.

Methods:

Over the last 20 years, 14 consecutive cases were diagnosed with GPN. MVD using a microasterional approach was performed in all patients. Demographic data, clinical presentation, surgical findings, clinical outcome, complications, and long-term follow-up were reviewed.

Results:

The median age of onset was 58.7 years. The mean time from onset of symptoms to treatment was 8.8 years. Glossopharyngeal and vagus nerve compression was from the posterior inferior cerebellar artery in eleven cases (78.5%), vertebral artery in two cases (14.2%), and choroid plexus in one case (7.1%). Postoperative mean follow-up was 26 months (3–180 months). Pain analysis demonstrated long-term pain improvement of 114 ± 27.1 months and pain remission in 13 patients (92.9%) (P = 0.0001) two complications were documented, one patient had a cerebrospinal fluid leak, and another had bacterial meningitis. There was no surgical mortality.

Conclusions:

GPN is a rare entity, and secondary causes should be discarded. MVD through a retractorless microasterional approach is a safe and effective technique. Our series demonstrated an excellent clinical outcome with pain remission in 92.9%.

Regional Cancer Pain Syndromes

Cancer pain often presents in a body region. This review summarizes articles from 1999-2004 relevant to cancer pain syndromes in the head and neck, chest, back, abdomen, pelvis, and limbs. Although the evidence is limited, progress is being made in further development of the evidence base to support and guide current practice.

Fully endoscopic vascular decompression of the glossopharyngeal nerve

Microvascular decompression of the glossopharyngeal nerve is an effective treatment of patients with glossopharyngeal neuralgia in whom compression of the nerve by a blood vessel is implicated in the pathogenesis of the disease. The standard surgical technique uses a binocular operating microscope for intra-operative visualization. Growing experience with posterior fossa endoscopy, however, has suggested that endoscopes may provide more comprehensive anatomical views of cerebellopontine angle. This report describes the case of a patient suffering from glossopharyngeal neuralgia who underwent fully endoscopic vascular decompression of the glossopharyngeal nerve. During this procedure the endoscope was used to survey the posterior fossa, guide the placement of insulating sponges, and conduct a final assessment of the intervention. We found the endoscope ideally suited to the constricted operating space of the posterior fossa, allowing for accurate localization and careful separation of the pathological vascular conflict with minimal brain retraction and no damage to surrounding structures. The versatility of endoscopy allows for superior visual appreciation of neurovascular conflicts in the posterior fossa. To date, endoscopy has primarily been used to supplement microscopy in cranial nerve decompression surgery. This report demonstrates how the endoscope can be used as the sole imaging modality in glossopharyngeal nerve decompression, with excellent results.