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Pain-free survival after vagoglossopharyngeal complex sectioning with or without microvascular decompression in glossopharyngeal neuralgia.
J Neurosurg 2019; :1-7JN

Abstract

OBJECTIVE

Glossopharyngeal neuralgia (GN) is a rare pain condition in which patients experience paroxysmal, lancinating throat pain. Multiple surgical approaches have been used to treat this condition, including microvascular decompression (MVD), and sectioning of cranial nerve (CN) IX and the upper rootlets of CN X, or a combination of the two. The aim of this study was to examine the long-term quality of life and pain-free survival after MVD and sectioning of the CN X/IX complex.

METHODS

A combined retrospective chart review and a quality-of-life telephone survey were performed to collect demographic and long-term outcome data. Quality of life was assessed by means of a questionnaire based on a combination of the Barrow Neurological Institute pain intensity scoring criteria and the Brief Pain Inventory-Facial. Kaplan-Meier analysis was performed to determine pain-free survival.

RESULTS

Of 18 patients with GN, 17 underwent sectioning of the CN IX/X complex alone or sectioning and MVD depending on the presence of a compressing vessel. Eleven of 17 patients had compression of CN IX/X by the posterior inferior cerebellar artery, 1 had compression by a vertebral artery, and 5 had no compression. One patient (6%) experienced no immediate pain relief. Fifteen (88%) of 17 patients were pain free at the last follow-up (mean 9.33 years, range 5.16-13 years). One patient (6%) experienced throat pain relapse at 3 months. The median pain-free survival was 7.5 years ± 10.6 months. Nine of 18 patients were contacted by telephone. Of the 17 patients who underwent sectioning of the CN IX/X complex, 13 (77%) patients had short-term complaints: dysphagia (n = 4), hoarseness (n = 4), ipsilateral hearing loss (n = 4), ipsilateral taste loss (n = 2), and dizziness (n = 2) at 2 weeks. Nine patients had persistent side effects at latest follow-up. Eight of 9 telephone respondents reported that they would have the surgery over again.

CONCLUSIONS

Sectioning of the CN IX/X complex with or without MVD of the glossopharyngeal nerve is a safe and effective surgical therapy for GN with initial pain freedom in 94% of patients and an excellent long-term pain relief (mean 7.5 years).

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30641844

Citation

Teton, Zoe E., et al. "Pain-free Survival After Vagoglossopharyngeal Complex Sectioning With or Without Microvascular Decompression in Glossopharyngeal Neuralgia." Journal of Neurosurgery, 2019, pp. 1-7.
Teton ZE, Holste KG, Hardaway FA, et al. Pain-free survival after vagoglossopharyngeal complex sectioning with or without microvascular decompression in glossopharyngeal neuralgia. J Neurosurg. 2019.
Teton, Z. E., Holste, K. G., Hardaway, F. A., Burchiel, K. J., & Raslan, A. M. (2019). Pain-free survival after vagoglossopharyngeal complex sectioning with or without microvascular decompression in glossopharyngeal neuralgia. Journal of Neurosurgery, pp. 1-7. doi:10.3171/2018.8.JNS18239.
Teton ZE, et al. Pain-free Survival After Vagoglossopharyngeal Complex Sectioning With or Without Microvascular Decompression in Glossopharyngeal Neuralgia. J Neurosurg. 2019 Jan 11;1-7. PubMed PMID: 30641844.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pain-free survival after vagoglossopharyngeal complex sectioning with or without microvascular decompression in glossopharyngeal neuralgia. AU - Teton,Zoe E, AU - Holste,Katherine G, AU - Hardaway,Fran A, AU - Burchiel,Kim J, AU - Raslan,Ahmed M, Y1 - 2019/01/11/ PY - 2018/01/29/received PY - 2018/08/14/accepted PY - 2019/1/16/entrez KW - AICA = anterior inferior cerebellar artery KW - BNI = Barrow Neurological Institute KW - BPI = Brief Pain Inventory KW - CN = cranial nerve KW - GN = glossopharyngeal neuralgia KW - Kaplan-Meier curve KW - MVD = microvascular decompression KW - NIN = nervus intermedius neuralgia KW - NVC = neurovascular compression KW - PICA = posterior inferior cerebellar artery KW - TN = trigeminal neuralgia KW - glossopharyngeal neuralgia KW - pain KW - pain-free survival SP - 1 EP - 7 JF - Journal of neurosurgery JO - J. Neurosurg. N2 - OBJECTIVEGlossopharyngeal neuralgia (GN) is a rare pain condition in which patients experience paroxysmal, lancinating throat pain. Multiple surgical approaches have been used to treat this condition, including microvascular decompression (MVD), and sectioning of cranial nerve (CN) IX and the upper rootlets of CN X, or a combination of the two. The aim of this study was to examine the long-term quality of life and pain-free survival after MVD and sectioning of the CN X/IX complex.METHODSA combined retrospective chart review and a quality-of-life telephone survey were performed to collect demographic and long-term outcome data. Quality of life was assessed by means of a questionnaire based on a combination of the Barrow Neurological Institute pain intensity scoring criteria and the Brief Pain Inventory-Facial. Kaplan-Meier analysis was performed to determine pain-free survival.RESULTSOf 18 patients with GN, 17 underwent sectioning of the CN IX/X complex alone or sectioning and MVD depending on the presence of a compressing vessel. Eleven of 17 patients had compression of CN IX/X by the posterior inferior cerebellar artery, 1 had compression by a vertebral artery, and 5 had no compression. One patient (6%) experienced no immediate pain relief. Fifteen (88%) of 17 patients were pain free at the last follow-up (mean 9.33 years, range 5.16-13 years). One patient (6%) experienced throat pain relapse at 3 months. The median pain-free survival was 7.5 years ± 10.6 months. Nine of 18 patients were contacted by telephone. Of the 17 patients who underwent sectioning of the CN IX/X complex, 13 (77%) patients had short-term complaints: dysphagia (n = 4), hoarseness (n = 4), ipsilateral hearing loss (n = 4), ipsilateral taste loss (n = 2), and dizziness (n = 2) at 2 weeks. Nine patients had persistent side effects at latest follow-up. Eight of 9 telephone respondents reported that they would have the surgery over again.CONCLUSIONSSectioning of the CN IX/X complex with or without MVD of the glossopharyngeal nerve is a safe and effective surgical therapy for GN with initial pain freedom in 94% of patients and an excellent long-term pain relief (mean 7.5 years). SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/30641844/Pain-free_survival_after_vagoglossopharyngeal_complex_sectioning_with_or_without_microvascular_decompression_in_glossopharyngeal_neuralgia L2 - https://thejns.org/doi/10.3171/2018.8.JNS18239 DB - PRIME DP - Unbound Medicine ER -