J Korean Neurosurg Soc.  2017 Nov;60(6):738-748. 10.3340/jkns.2017.0506.010.

Microvascular Decompression for Glossopharyngeal Neuralgia: Clinical Analyses of 30 Cases

• Kim MK
• Park JS
• Ahn YH

• KMID: 2395795
• DOI: http://doi.org/10.3340/jkns.2017.0506.010

Abstract

OBJECTIVE
We present our experience of microvascular decompression (MVD) for glossopharyngeal neuralgia (GPN) and evaluate the postoperative outcomes in accordance with four different operative techniques during MVD.
METHODS
In total, 30 patients with intractable primary typical GPN who underwent MVD without rhizotomy and were followed for more than 2 years were included in the analysis. Each MVD was performed using one of four different surgical techniques: interposition of Teflon pieces, transposition of offending vessels using Teflon pieces, transposition of offending vessels using a fibrin-glue-coated Teflon sling, and removal of offending veins.
RESULTS
The posterior inferior cerebellar artery was responsible for neurovascular compression in 27 of 30 (90%) patients, either by itself or in combination with other vessels. The location of compression on the glossopharyngeal nerve varied; the root entry zone (REZ) only (63.3%) was most common, followed by both the REZ and distal portion (26.7%) and the distal portion alone (10.0%). In terms of detailed surgical techniques during MVD, the offending vessels were transposed in 24 (80%) patients, either using additional insulation, offered by Teflon pieces (15 patients), or using a fibrin glue-coated Teflon sling (9 patients). Simple insertion of Teflon pieces and removal of a small vein were also performed in five and one patient, respectively. During the 2 years following MVD, 29 of 30 (96.7%) patients were asymptomatic or experienced only occasional pain that did not require medication. Temporary hemodynamic instability occurred in two patients during MVD, and seven patients experienced transient postoperative complications. Neither persistent morbidity nor mortality was reported.
CONCLUSION
This study demonstrates that MVD without rhizotomy is a safe and effective treatment option for GPN.

Keyword

Glossopharyngeal nerve diseases; Neuralgia; Microvascular decompression surgery; Polytetrafluoroethylene

MeSH Terms

Arteries
Fibrin
Glossopharyngeal Nerve
Glossopharyngeal Nerve Diseases*
Hemodynamics
Humans
Microvascular Decompression Surgery*
Mortality
Neuralgia
Polytetrafluoroethylene
Postoperative Complications
Rhizotomy
Veins
Fibrin
Polytetrafluoroethylene

Figure

• 

  Fig. 1 Magnetic resonance image of the left posterior inferior cerebellar artery in contact with the root entry zone of the left glossopharyngeal nerve. A: Three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA). B: Three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA).

• 

  Fig. 2 Intraoperative images of microvascular decompression of the glossopharyngeal root entry zone from an offending artery in patients with glossopharyngeal neuralgia. A: Transposition using a fibrin glue-coated Teflon sling retraction. B: Interposition using Teflon pieces. PICA: posterior inferior cerebellar artery.

Reference

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