Glossopharyngeal Neuralgia

Efficacy and safety of stereotactic radiosurgery for idiopathic glossopharyngeal neuralgia: A systematic review and meta-analysis

BACKGROUND

We performed this study to comprehensively assess the efficacy and safety of stereotactic radiosurgery (SRS) in patients with glossopharyngeal neuralgia (GPN).

METHODS

Searches of PubMed, Embase, Cochrane Library, and Web of Science were performed from inception to date. The protocol for this study was registered with the PROSPERO international prospective register of systematic reviews.

RESULTS

A total of seven studies involving 79 patients were included. At the last follow-up, the pooled proportion of patients achieving Barrow Neurological Institute (BNI) grade I was 37.5 % (95 % CI: 26.2 %-49.3 %). The proportion of patients attaining BNI grades I-IIIa was 58.5 % (95 % CI: 46.6 %-70.1 %). In terms of treatment failure, the pooled rate was 11.9 % (95 % CI: 4.6 %-21.3 %). Regarding recurrence, the pooled rate was 23.1 % (95 % CI: 13.4 %-34.0 %). The pooled complication rate was 0.2 % (95 % CI: 0.0 %-4.4 %). Among those who experienced treatment failure after microvascular decompression (MVD), 41.67 % (5/12) reached BNI grades I-IIIb, while 66.67 % (4/6) of those who failed rhizotomy achieved BNI grades I-IIIa. A total of 18 patients underwent repeat SRS; Of these, 44.4 % (8/18) achieved BNI grade I, and 66.7 % (12/18) attained BNI grades I-IIIa.

CONCLUSION

This study demonstrated that SRS is an acceptable treatment for idiopathic GPN, offering effective pain relief with an extremely low complication rate. It could serve as a valuable salvage therapy for those who have not achieved success with MVD or rhizotomy. Repeat SRS remains effective for patients experiencing recurrence.

Glossopharyngeal neuralgia and hypoglossal nerve palsy: A singular clinical case of two rare concomitant neurovascular conflicts

Background

Neurovascular conflict (NVC) is described as a pathological contact between cranial nerves and vessels. Glossopharyngeal neuralgia (GPN) and hypoglossal nerve palsy (HNP) due to NVC represent rare clinical entities. To our knowledge, we present the first reported case of concomitant GPN and HNP caused by vertebral artery (VA)-posterior inferior cerebellar artery (PICA) complex compression.

Case Description

We report an extremely rare case of a 52-year-old man with combined unilateral left-sided GPN and HNP because of NVC involving both the VA and the PICA, successfully treated with a retrosigmoid approach for microvascular decompression (MVD). Postoperatively, the patient immediately recovered without new-onset dysfunction of lower cranial nerves, and a complete remission of symptoms was achieved.

Conclusion

As far as we know, in this article, we present the first singular case in the literature of concomitant classical GPN and HNP due to NVC involving both the VA and the PICA. Despite the low incidence of GPN and HNP, clinical picture and intraoperative findings represent clear and reliable elements for their diagnosis. MVD is a successful therapeutic strategy that offers a long-term cure for GPN and HNP.

Diagnostic and treatment pitfalls in glossopharyngeal neuralgia: evidence from a case series

BACKGROUND

Glossopharyngeal neuralgia (GN) is a rare pain syndrome often underdiagnosed. This study aimed to assess the challenges in diagnosing GN and identify patients at risk of misdiagnosis.

METHODS

Between 2010 and 2019, nine patients underwent microvascular decompression (MVD) of the glossopharyngeal nerve at two tertiary care hospitals. A retrospective analysis examined symptom characteristics, time to correct diagnosis, operative technique, and clinical outcomes. Barrow Neurological Institute (BNI) pain scores were assessed before surgery and on follow-up.

RESULTS

Six women and three men, aged 55 ± 14.3 years, with unilateral GN were included. Pain was predominantly in the ear (otalgic type) in four patients (44.4%), the pharynx or base of the tongue (pharyngeal type) in four (44.4%), and mixed in one (11.1%). Five patients reported pain radiating to the mandible, all initially misdiagnosed with trigeminal neuralgia (TN) and treated for 2.4(± 3.1) years before presenting to our institution. One case resulted in MVD of the trigeminal nerve and subsequent thermocoagulation of the Gasserian ganglion due to persistent pain. The correct diagnosis of GN was established later in patients with otalgic or mixed pain (3.8 ± 3.4 years) compared to those with pharyngeal pain (0.5 ± 1.0 years), showing a trend (U = 17.0, p = 0.07). There was a significant association between pain radiation to the mandible and misdiagnosis (x2 = 9.00, p = 0.003). Endoscopically assisted MVD via the median suboccipital subtonsillary approach was performed, resolving neurovascular conflicts with the PICA (9/9) and vertebral artery (3/9). Follow-up after 15.7(± 18.2) months showed significant pain reduction according to the BNI (preoperative BNI = 5.0 ± 0.0, postoperative BNI = 1.7 ± 1.0,t (8) = 10,CI [1.6-5.1], p < 0.001). No permanent surgery-related deficits occurred.

CONCLUSION

Patients with GN, especially those with predominant otalgic pain and pain radiating to the mandible, are at higher risk of misdiagnosis due to similarities with TN. Despite the rarity of GN, increased awareness of its various pain manifestations may lead to earlier correct diagnoses, which is crucial for surgical treatment.

Cranial Neuralgias

OBJECTIVE

The cranial neuralgias are relatively rare, but recognizing these syndromes and distinguishing among them is critical to reducing unnecessary pain and disability for affected patients. Despite their distinctive features, cranial neuralgias may go undiagnosed or misdiagnosed for several years. A notable proportion of cranial neuralgia presentations are due to secondary causes and require targeted treatment. The purpose of this article is to review the diagnosis and management of cranial neuralgias encountered in clinical practice.

LATEST DEVELOPMENTS

In 2020, the International Classification of Orofacial Pain was released for the first time. Modeled after the International Classification of Headache Disorders, it includes updated terminology for cranial neuralgias. The underlying pathophysiology of the cranial neuralgias is currently believed to be rooted in both peripheral and central nociceptive systems. In addition, a growing number of familial cases are being identified. Recent therapeutic advancements include a better understanding of how to utilize older therapies and procedures more effectively as well as the development of newer approaches.

ESSENTIAL POINTS

Cranial neuralgia syndromes are rare but important to recognize due to their debilitating nature and greater likelihood of having potentially treatable underlying causes. While management options have remained somewhat limited, scientific inquiry is continually advancing the understanding of these syndromes and how best to address them.

Long-Term Follow-Up of Ultrasound-Guided Glossopharyngeal Nerve Block Treatment for Glossopharyngeal Neuralgia: A Retrospective Clinical Study of 43 Cases

Background

Glossopharyngeal neuralgia (GPN) is a rare chronic neuropathic pain disorder that significantly impacts quality of life. Ultrasound-guided glossopharyngeal nerve blocks (UGPNB) have gained popularity due to their various advantages. However, there have been no studies reporting the long-term outcomes of UGPNB in a larger cohort of GPN patients.

Aim

This study aims to evaluate the efficacy and safety of UGPNB in patients with GPN.

Methods

We reviewed the electronic medical records of patients with GPN who received UGPNB at the Department of Pain Medicine of the First Medical Center, PLA General Hospital between June 1, 2011, and June 1, 2022. The effect of UGPNB was evaluated using the Barrow Neurological Institute (BNI) scale. Improvement was defined as a reduction in pain category by comparing pain categories before and after therapy. Recovery was defined as achieving BNI I after treatment. Patients who responded to treatment but then regressed to the category before therapy were considered to have experienced pain relapse.

Results

A total of 43 patients with GPN who received UGPNB were included in the analysis. At discharge, 35 (81.4%) patients experienced pain improvement after treatment, and among them, 13 (30.2%) patients achieved recovery. After discharge, 13 patients (37.1%) out of the 35 effective patients experienced pain relapse at different time intervals: 0.5, 0.7, 1, 1, 3, 3, 4, 12, 15, 36, 45, 63, and 96 months. The cumulative recurrence-free survival rates were 88.85% at month 1, 82.83% at month 3, 77.04% at month 12, 70.31% at month 36, and 54.66% at month 120. Among the 13 patients who experienced relapse, four patients received a second UGPNB treatment, and pain improved in two patients (50%). No severe adverse reactions were documented.

Conclusion

UGPNB is an effective, repeatable, safe, and minimally invasive treatment for patients with GPN. It may be preferable to consider UGPNB before undergoing invasive intracranial surgery or neurodestructive methods.

Hypoglossal and Glossopharyngeal Nerve Palsy After Anterior Cervical Decompression and Fusion: A Case Report

CASE

A 69-year-old man underwent a C3-4 anterior cervical discectomy and fusion and developed postoperative hypoglossal and glossopharyngeal palsies that resolved with symptomatic treatment.

CONCLUSION

Cranial nerve palsy is a rare and possibly under-reported injury after higher-level cervical spine surgery. Conscientious positioning and awareness of these nerves during surgical exposure are crucial to minimizing cranial nerve palsies. Proper workup to identify these palsies and differentiate them from other complications is necessary to guide proper treatment.

Glossopharyngeal Neuralgia Characterized by Otalgia: A Retrospective Study

Glossopharyngeal neuralgia (GPN) is an uncommon facial pain syndrome and is characterized by paroxysms of excruciating pain in the distributions of the auricular and pharyngeal branches of cranial nerves IX and X. Glossopharyngeal neuralgia characterized by otalgia alone is rare. Herein, the authors analyzed 2 patients with GPN with otalgia as the main clinical manifestation. The clinical features and prognosis of this rare group of patients with GPN were discussed. They both presented with paroxysmal pain in the external auditory meatus and preoperative magnetic resonance imaging suggested the vertebral artery were closely related to the glossopharyngeal nerves. In both patients, compression of the glossopharyngeal nerve was confirmed during microvascular decompression, and the symptoms were relieved immediately after surgery. At 11 to 15 months follow-up, there was no recurrence of pain. A variety of reasons can cause otalgia. The possibility of GPN is a clinical concern in patients with otalgia as the main complaint. The authors think the involvement of the glossopharyngeal nerve fibers in the tympanic plexus via Jacobson nerve may provide an important anatomic basis for GPN with predominant otalgia. Surface anesthesia test of the pharynx and preoperative magnetic resonance imaging is helpful for diagnosis. Microvascular decompression is effective in the treatment of GPN with predominant otalgia.

Operative Findings of over 5000 Microvascular Decompression Surgeries for Hemifacial Spasm: Our Perspective and Current Updates

Hemifacial spasm (HFS) is a hyperactive cranial neuropathy, and it has been well established that the cause of primary HFS is compression on the root exit zone (REZ) of the facial-vestibulocochlear nerve complex (CN VII-VIII) by a vessel or vessels. MVD is the only curative treatment option for HFS with a high success rate and low incidence of recurrence and complications. We categorize six classical compressive patterns on the REZ as well as five challenging types. Knowledge of these patterns may help in achieving a better surgical outcome.