Stereotactic radiosurgery for glossopharyngeal neuralgia: preliminary report of 5 cases

Clinical article

Restricted access

Object

Glossopharyngeal neuralgia (GPN) is a rare pain disorder characterized by severe, stabbing pain of the ear, posterior tongue, and throat. The authors report their early experience of using stereotactic radiosurgery (SRS) as an alternative to posterior fossa surgery for patients with medically resistant GPN.

Methods

Five patients (3 men, 2 woman) with medically resistant GPN underwent Gamma Knife surgery. The radiosurgical target was the distal portion of the glossopharyngeal and vagus nerves at the jugular foramen (glossopharyngeal meatus). The maximum radiation dose in all cases was 80 Gy. The median follow-up after radiosurgery was 13 months (range 2–19 months).

Results

Three patients became pain-free at 2 days, 3 days, and 2 weeks, respectively, and were able to discontinue the medications taken preoperatively for their pain. None of these patients have suffered recurrent pain since becoming pain free. Two patients experienced no benefit from the procedure and underwent posterior fossa surgery 2 and 5 months after SRS. Both of these patients continued to have pain after posterior fossa surgery. One of these patients was later discovered to have a head and neck cancer as the cause of his pain. No patient developed hoarseness or dysphagia after radiosurgery.

Conclusions

This preliminary experience demonstrates that SRS is an option for patients with medically resistant GPN. Additional follow-up and a larger number of patients are needed to demonstrate the long-term safety and optimal radiation dosimetry for this indication.

Abbreviations used in this paper: GPN = glossopharyngeal neuralgia; MVD = microvascular decompression; SRS = stereotactic radiosurgery.

Article Information

Address correspondence to: Bruce E. Pollock, M.D., Department of Neurological Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. email: pollock.bruce@mayo.edu.

Please include this information when citing this paper: published online July 8, 2011; DOI: 10.3171/2011.5.JNS1133.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Axial images showing the radiosurgical target in a representative patient. Left: Fused, Gd-enhanced, spoiled gradient–recalled acquisition MR imaging sequence and CT scan showing radiosurgical dose plan (circles) targeting the glossopharyngeal nerve (arrowhead) at the level of the glossopharyngeal meatus. The maximum prescribed radiation dose was 80 Gy. Right: Computed tomography scan demonstrating the adjacent anatomy: pars nervosa of the jugular foramen (asterisk), jugular bulb (arrowhead), carotid canal (arrow).

References

1

Dieleman JPKerklaan JHuygen FJBouma PASturkenboom MC: Incidence rates and treatment of neuropathic pain conditions in the general population. Pain 137:6816882008

2

Dhople AAAdams JRMaggio WWNaqvi SARegine WFKwok Y: Long-term outcomes of Gamma Knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature. Clinical article. J Neurosurg 111:3513582009

3

Ferrante LArtico MNardacci BFraioli BCosentino FFortuna A: Glossopharyngeal neuralgia with cardiac syncope. Neurosurgery 36:58631995

4

Kondziolka DZorro OLobato-Polo JKano HFlannery TJFlickinger JC: Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia. Clinical article. J Neurosurg 112:7587652010

5

Laha RKJannetta PJ: Glossopharyngeal neuralgia. J Neurosurg 47:3163201977

6

Linn JMoriggl BSchwarz FNaidich TPSchmid UDWiesmann M: Cisternal segments of the glossopharyngeal, vagus, and accessory nerves: detailed magnetic resonance imaging-demonstrated anatomy and neurovascular relationships. Clinical article. J Neurosurg 110:102610412009

7

Patel AKassam AHorowitz MChang YF: Microvascular decompression in the management of glossopharyngeal neuralgia: analysis of 217 cases. Neurosurgery 50:7057112002

8

Pollock BEPhuong LKFoote RLStafford SLGorman DA: High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction. Neurosurgery 49:58642001

9

Régis JMetellus PHayashi MRoussel PDonnet ABille-Turc F: Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia. J Neurosurg 104:9139242006

10

Resnick DKJannetta PJBissonnette DJho HDLanzino G: Microvascular decompression for glossopharyngeal neuralgia. Neurosurgery 36:64691995

11

Rhoton AL JrBuza R: Microsurgical anatomy of the jugular foramen. J Neurosurg 42:5415501975

12

Riesenburger RIHwang SWSchirmer CMZerris VWu JKMahn K: Outcomes following single-treatment Gamma Knife surgery for trigeminal neuralgia with a minimum 3-year follow-up. Clinical article. J Neurosurg 112:7667712010

13

Rozen TD: Trigeminal neuralgia and glossopharyngeal neuralgia. Neurol Clin 22:1852062004

14

Rushton JGStevens JCMiller RH: Glossopharyngeal (vagoglossopharyngeal) neuralgia: a study of 217 cases. Arch Neurol 38:2012051981

15

Sampson JHGrossi PMAsaoka KFukushima T: Microvascular decompression for glossopharyngeal neuralgia: long-term effectiveness and complication avoidance. Neurosurgery 54:8848902004

16

Stieber VWBourland JDEllis TL: Glossopharyngeal neuralgia treated with gamma knife surgery: treatment outcome and failure analysis. Case report. J Neurosurg 102:Suppl1551572005

17

Taha JMTew JM Jr: Long-term results of surgical treatment of idiopathic neuralgias of the glossopharyngeal and vagal nerves. Neurosurgery 36:9269311995

18

Williams BJSchlesinger DSheehan J: Glossopharyngeal neuralgia treated with gamma knife radiosurgery. World Neurosurg 73:4134172010

19

Yomo SArkha YDonnet ARégis J: Gamma Knife surgery for glossopharyngeal neuralgia. Report of 2 cases. J Neurosurg 110:5595632009

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 50 50 12
Full Text Views 105 105 9
PDF Downloads 104 104 6
EPUB Downloads 0 0 0

PubMed

Google Scholar