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.
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.
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.
Because of its safety and efficacy, GKRS appears to be a useful tool for treatment of GPN, including first-line treatment.
DhopleAAAdamsJRMaggioWWNaqviSARegineWFKwokY: Long-term outcomes of Gamma Knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature. Clinical article. J Neurosurg111:351–3582009
FerroliPFioravantiASchiaritiMTringaliGFranziniACalbucciF: Microvascular decompression for glossopharyngeal neuralgia: a long-term retrospectic review of the Milan-Bologna experience in 31 consecutive cases. Acta Neurochir (Wien)151:1245–12502009
HayashiMOchiaiTNakayaKChernovMTamuraNYomoS: Image-guided microradiosurgery for skull base tumors: advantages of using gadolinium-enhanced constructive interference in steady-state imaging. J Neurosurg105 Suppl:12–172006
Headache Classification Committee of the International Headache Society (IHS): The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia Int J Headache33:629–8082013
RégisJTuleascaCResseguierNCarronRDonnetAGaudartJ: Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study. J Neurosurg124:1079–10872016
RogersCLShetterAGFiedlerJASmithKAHanPPSpeiserBL: Gamma Knife radiosurgery for trigeminal neuralgia: the initial experience of the Barrow Neurological Institute. Int J Radiat Oncol Biol Phys47:1013–10192000
TanrikuluLHastreiterPDörflerABuchfelderMNaraghiR: Classification of neurovascular compression in glossopharyngeal neuralgia: Three-dimensional visualization of the glossopharyngeal nerve. Surg Neurol Int6:1892015
TuleascaCCarronRResseguierNDonnetARousselPGaudartJ: Decreased probability of initial pain cessation in classic trigeminal neuralgia treated with Gamma Knife surgery in case of previous microvascular decompression: a prospective series of 45 patients with >1 year of follow-up. Neurosurgery77:87–952015
XiongNXTanDFuPZhaoHY: Gamma Knife radiosurgery for glossopharyngeal neuralgia by targeting the medial cisternal segment of the glossopharyngeal nerve: report of 3 cases. Stereotact Funct Neurosurg93:292–2962015