Gamma Knife Treatment of Pain Syndromes of the Glossopharyngeal Area


Authors: D. Urgošík;  R. Liščák
Authors‘ workplace: Oddělení stereotaktické a radiační neurochirurgie, Nemocnice Na Homolce, Praha
Published in: Cesk Slov Neurol N 2016; 79/112(3): 331-335
Category: Short Communication
doi: https://doi.org/10.14735/amcsnn2016331

Overview

Patients and Methods:
We used Gamma Knife (dose of 80 Gy) to irradiate inferior glossopharyngeal ganglion in 12 patients. Six patients had typical glossopharyngeal neuralgia (GFN), 3 had a combination of GFN and neuralgia in the 3rd branch of the trigeminal nerve (GFN_TN) and 3 had secondary pain in glossopharyngeal area (F : M = 9 : 3; mean age 61.5 years, SD ± 9.7; follow-up 6–120 months, median 76.5). Pain relief was assessed using Barrow Neurological Institute (BNI) scores and side effects by neurological examination.

Results:
We achieved successful pain relief (BNI I–III) in eight patients of the nine GFN and GFN_TN patients (88.8%). Complete pain relief (BNI I and II) was observed in six patients (75%) and treatment failed in one patient. Three patients with secondary pain had no pain relief. Recurrent pain in glossopharyngeal area occurred in two (25%) patients. “False” relapses in the untreated area of the 3rd branch of the trigeminal nerve manifested in GFN_TN. Second irradiation of the inferior ganglion in GFN patients (two with recurrence and one with unsatisfactory response) and radiation of the trigeminal nerve in GFN_TN patients (two patients with “false” relapses) led to complete pain relief (BNI I and II ). In total, first and second irradiation was successful in all nine patients with GFN and GFN_TN.

Conclusion:
Gamma knife is an additional treatment option in patients with GFN with a good chance for relief and with minimal side-effects.

Key words:
gamma knife – radiosurgery – glossopharyngeal neuralgia – trigeminal neuralgia

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. Taha JM, Tew JM. Long-term results of surgical treatment of idiopathic neuralgias of the glos­sopharyngeal and vagal nerves. Neurosurgery 1995;36:926–31.

2. Chalmers AC, Olson JL. Glos­sopharyngeal neuralgia with syncope and cervical mas­s. Otolaryngol Head Neck Surg 1989;100(3):252–5.

3. Skřivan J, Betka J. Bolesti v orofaciální oblasti. In: Rokyta R, Kršiak M, Kozák J, eds. Bolest. Praha: Tigis 2006:508–14.

4. Katusic S, Wil­liams DB, Beard CM, et al. Epidemiology and clinical features of idiopathic trigeminal neuralgia and glos­sopharyngeal neuralgia: similarities and dif­ferences, Rochester, Min­nesota 1945– 1984. Neuroepidemiology 1991;10(5–6):276–81.

5. Bescós A, Pascual V, Escosa-Bage M, et al. Treatment of trigeminal neuralgia: an update and future prospects of percutaneous techniques. Rev Neurol 2015;61(3):114–24.

6. Manzoni GC, Torel­li P. Epidemiology of typical and atypical craniofacial neuralgias. Neurol Sci 2005;26(Suppl 2):65–7.

7. Lazorthes Y, Verdie JC. Radiofrequency coagulation of thepetrous ganglion in glos­sopharyngeal neuralgia. Neurosurgery 1979;4(6):512–6.

8. Houdek M, Burval S. Thermocoagulation of Andersch‘s ganglion (ganglion inferius n. glos­sopharyngei) in the treatment of glos­sopharyngeal neuralgia. Acta Univ Palacky Olomuc Fac Med 1990;128:93–9.

9. Ma Y, Li YF, Wang QC, et al. Neurosurgical treatment of glos­sopharyngeal neuralgia: analysis of 103 cases. J Neurosurg 2016;124(4):1088–92. doi: 10.3171/2015.3. JNS141806.

10. Jan­netta PJ. Neurovascular compres­sion in cranial nerve andsystemic disease. Ann Surg 1980;192:518–25.

11. Patel A, Kas­sam A, Horowitz M, et al. Microvascular decompres­sion in the management of glos­sopharyngeal neuralgia: analysis of 217 cases. Neurosurgery 2002;50(4):705–11.

12. Kunc Z. Treatment of es­sential neuralgia of the 9th nerve by selective tractotomy. J Neurosurg 1965;23(5):494–500.

13. Chen J, Sindou M. Vago-glos­sopharyngeal neuralgia: a literature review of neurosurgical experience. Acta Neurochir 2015;157(2):311–21. doi: 10.1007/s00701-014-2302-7.

14. Urgosik D, Liscak R, Novotny J jr, et al. Treatment of es­sential trigeminal neuralgia with gam­ma knife surgery. J Neurosurg 2005;102(Suppl):29–33.

15. Stieber VW, Bourland JD, El­lis TL. Glos­sopharyngeal neuralgia treated with gam­ma knife surgery: treatment outcome and failure analysis. J Neurosurg 2005;102(Suppl):155–7.

16. Yomo S, Arkha Y, Don­net A, et al. Gam­ma Knife surgery for glos­sopharyngeal neuralgia. J Neurosurg 2009;110(3):559– 63. doi: 10.3171/2008.8.17641.

17. Wil­liams BJ, Schlesinger D, Sheehan J. Glos­sopharyngeal neuralgia treated with gam­ma knife radiosurgery. World Neurosurg 2010;73(4):413– 7. doi: 10.1016/j.wneu.2010.01.007.

18. Pol­lock BE, Boes CJ. Stereotactic radiosurgery for glos­sopharyngeal neuralgia: preliminary report of 5 cases. J Neurosurg 2011;115(5):936– 9. doi: 10.3171/2011.5.JNS1133.

19. Leveque M, Park MC, Melhaoul A, et al. Gam­ma Knife radiosurgery for glos­sopharyngeal neuralgia, Marseil­le experience. J Radiosurg SBRT 2011;1(1):41–6.

20. Stanic S, Franklin SD, Pappas CT, et al. Gam­ma knife radiosurgery for recur­rent glos­sopharyngeal neuralgia after microvascular decompres­sion. Stereotact FunctNeurosurg 2012;90(3):188–91. doi: 10.1159/000338089.

21. O‘Con­nor JK, Bidiwala S. Ef­fectiveness and safety of Gam­ma Knife radiosurgery for glos­sopharyngeal neuralgia. Proc (Bayl Univ Med Cent) 2013;26(3):262–4.

22. Martínez-Álvarez R, Martínez-Moreno N, Kusak ME, et al. Glos­sopharyngeal neuralgia and radiosurgery. J Neurosurg 2014;121(Suppl):222–5. doi: 10.3171/2014.8. GKS141273.

23. Xiong NX, Tan D, Fu P, et al. Gam­ma knife radiosurgery for glos­sopharyngeal neuralgia by target­ing the medial cisternal segment of the glos­sopharyngeal nerve: report of 3 cases. Stereotact Funct Neurosurg 2015;93(4):292–6. doi: 10.1159/000375176.

24. Chen IH, Lee JY. The measurement of pain in patients with trigeminal neuralgia. Clin Neurosurg 2010;57: 129–33.

25. Sampson JH, Gros­si PM, Asaoka K, et al. Microvascular decompres­sion for glos­sopharyngeal neuralgia: long-term ef­fectiveness and complication avoidance. Neurosurgery 2004;54(4):884–9.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2016 Issue 3

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account