Diagnosis and neurosurgical treatment of glossopharyngeal neuralgia: clinical findings and 3-D visualization of neurovascular compression in 19 consecutive patients |
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Authors: | C Gaul P Hastreiter A Duncker R Naraghi |
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Institution: | 1.Department of Neurology,University Duisburg-Essen,Essen,Germany;2.Department of Anaesthesiology and Operative Intensive Care,Martin-Luther-University Halle-Wittenberg,Halle,Germany;3.Department of Neurosurgery,Armed Forces Hospital Ulm,Ulm,Germany |
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Abstract: | Glossopharyngeal neuralgia is a rare condition with neuralgic sharp pain in the pharyngeal and auricular region. Classical
glossopharyngeal neuralgia is caused by neurovascular compression at the root entry zone of the nerve. Regarding the rare
occurrence of glossopharyngeal neuralgia, we report clinical data and magnetic resonance imaging (MRI) findings in a case
series of 19 patients, of whom 18 underwent surgery. Two patients additionally suffered from trigeminal neuralgia and three
from additional symptomatic vagal nerve compression. In all patients, ipsilateral neurovascular compression syndrome of the
IX cranial nerve could be shown by high-resolution MRI and image processing, which was confirmed intraoperatively. Additional
neurovascular compression of the V cranial nerve was shown in patients suffering from trigeminal neuralgia. Vagal nerve neurovascular
compression could be seen in all patients during surgery. Sixteen patients were completely pain free after surgery without
need of anticonvulsant treatment. As a consequence of the operation, two patients suffered from transient cerebrospinal fluid
hypersecretion as a reaction to Teflon implants. One patient suffered postoperatively from deep vein thrombosis and pulmonary
embolism. Six patients showed transient cranial nerve dysfunctions (difficulties in swallowing, vocal cord paresis), but all
recovered within 1 week. One patient complained of a gnawing and burning pain in the cervical area. Microvascular decompression
is a second-line treatment after failure of standard medical treatment with high success in glossopharyngeal neuralgia. High-resolution
MRI and 3D visualization of the brainstem and accompanying vessels as well as the cranial nerves is helpful in identifying
neurovascular compression before microvascular decompression procedure. |
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