Glossopharyngeal neuralgia treated by Gamma Knife radiosurgery: safety and efficacy through long-term follow-up

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OBJECTIVE

Glossopharyngeal neuralgia (GPN) is a rare and disabling condition. Just as for trigeminal neuralgia, Gamma Knife radiosurgery (GKRS) is increasingly proposed as a therapeutic option for GPN. The purpose of this study was to assess long-term safety and efficacy of GKRS for this indication.

METHODS

From 2007 to 2015, 9 patients (4 male and 5 female) underwent a total of 10 GKRS procedures. All of the patients presented with GPN that was refractory to all medical treatment, and all had a long history of pain. One patient had previously undergone surgical microvascular decompression. In 5 cases, a neurovascular conflict had been identified on MRI. For the GKRS procedure, the glossopharyngeal nerve was localized on MRI and CT under stereotactic conditions. The target was located at the glossopharyngeal meatus of the jugular foramen. The dose administered to the nerve was 80 Gy in 3 procedures and 90 Gy in the others. Follow-up was planned for 3, 6, and 12 months after the procedure and annually thereafter.

RESULTS

Eight patients experienced an improvement in their pain. The median length of time from GKRS to symptom improvement in this group was 7 weeks (range 2–12 months). At the first follow-up, 6 patients were pain-free (pain intensity scores of I–III, based on an adaptation of the Barrow Neurological Institute scoring system for trigeminal neuralgia), including 4 patients who were also medication-free (I). One patient had partial improvement (IV) and 2 patients had no change. The mean duration of follow-up was 46 months (range 10–90 months). At the last follow-up 6 patients remained pain-free (pain scores of I–III), including 4 patients who were pain free with no medication (I). No side effect was observed.

CONCLUSIONS

Because of its safety and efficacy, GKRS appears to be a useful tool for treatment of GPN, including first-line treatment.

ABBREVIATIONS BNI = Barrow Neurological Institute; CN = cranial nerve; FIESTA = fast imaging employing steady-state acquisition; GKRS = Gamma Knife radiosurgery; GPN = glossopharyngeal neuralgia; IHS = International Headache Society; MVD = microvascular decompression; VGPN = vago-glossopharyngeal neuralgia.

Article Information

Correspondence Benjamin Pommier, Service de Neurochirurgie, Hôpital nord - F-42055 Saint-Etienne Cedex 2, France. email: benjamin.pommier@neurochirurgie.fr.

INCLUDE WHEN CITING Published online June 16, 2017; DOI: 10.3171/2017.3.JNS162542.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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    FIESTA MR images fused with CT from Leksell GammaPlan software displaying axial (A), sagittal (B), and coronal (C) plans. The green outline represents the 80% isodose line. Figure is available in color online only.

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    Actuarial probability of maintaining pain relief with (A) and without (B) medication in our cohort. (The broken lines indicate the upper and lower bounds of the 95% confidence interval.) The actuarial probability of maintaining pain relief from 6 to 35 months was 88%; the probability of maintaining pain relief after 36 months was 58%. The actuarial probability of maintaining pain relief without medication from 6 to 35 months was 62%, and the probability of maintaining pain relief without medication after 36 months was 31%.

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