J Korean Neurosurg Soc.  2023 Jan;66(1):12-23. 10.3340/jkns.2022.0178.

Glossopharyngeal Neuralgia

• Park JS
• Ahn YH

• KMID: 2537844
• DOI: http://doi.org/10.3340/jkns.2022.0178

Abstract

Glossopharyngeal neuralgia (GPN) is a rare disease that must be differentiated from trigeminal neuralgia. The purpose of this article is to provide a comprehensive review of anatomy, pathophysiology, diagnostic criteria, and several options of treatment for GPN. Lessons learned through our experience of treating GPN are presented in detail, as well as cases of misdiagnosis and diagnostic pitfalls. Microvascular decompression (MVD) should be primarily considered for medically intractable GPN. Techniques employed in MVD for GPN are categorized and described. Especially, we underscore the advantages of the ‘transposition’ technique where insulating material is positioned ‘off’ the root entry zone (REZ), instead of ‘on’ it. We believe this ‘off-the-REZ’ technique can fundamentally prevent recurrence, if applicable. In addition, Gamma Knife radiosurgery can be an alternative option when a patient is ineligible for MVD, though it is categorized as a destructive procedure.

Keyword

Glossopharyngeal nerve diseases; Microvascular decompression surgery; Trigeminal neuralgia

Figure

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  Fig. 1. A : Computed tomography (CT) guided navigation for identification of the sigmoid sinus and mastoid air cells. B : Postoperative 3D CT image showing the size and shape of the suboccipital craniotomy.

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  Fig. 2. Simple transposition using Teflon pieces. A : Posterior inferior cerebellar artery (PICA) is compressing the root entry zone (REZ) (arrow) of the IX and X nerve. B : The position and trajectory of PICA is altered by the inserted Teflon. PICA is now moved behind Teflon (not visible in the picture. Also, note that Teflon is positioned 'off' the REZ). Since Teflon is not used as an insulation material on the REZ, we define this technique 'transposition'. IX : the glossopharyngeal nerve, X : the vagus nerve.

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  Fig. 3. Transposition using a Teflon sling. A : Very tortuous posterior inferior cerebellar artery (PICA) is compressing the root entry zone (REZ) of the IX and X nerves (white arrow : proximal PICA compressing the REZ of the CN IX-X complex; white arrowhead : distal PICA compressing the cisternal portion of the CN IX-X complex; black arrowheads : the CN IX-X complex). B : Tortuous PICA compressing the REZ and the cisternal portion of the CN IX-X complex. C : A fibrin-glue coated sling is pulling PICA away from the REZ, resulting in a change of the position and tracjectory of PICA. Through this 'tranposition' technique, both the REZ and cisternal portion of the CN IX-X complex can be decompressed. IX : the glossopharyngeal nerve, X : the vagus nerve.

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  Fig. 4. Interposition of insulating material (IM). A : Posterior inferior cerebellar artery (PICA) compressing the IX nerve. B and C : while PICA being maneuvered, it appears unfeasible to transpose PICA to another position, owing to several perforators tethering PICA to the brain stem. D : Teflon pieces are inserted as an IM. IX : the glossopharyngeal nerve, X : the vagus nerve.

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  Fig. 5. Manually crafted glue-coated Teflon. The scale indicates 1 mm. A : Several pieces of Teflon are manually twisted. B : Fibrin glue coated Teflon sling is lint free and sleek.

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