Department of Neurosurgery, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
J Clin Neurosci. 2012 Apr;19(4):614-6. doi: 10.1016/j.jocn.2011.05.040. Epub 2012 Jan 25.
A 34-year-old woman presented with disabling right-sided glossopharyngeal neuralgia. MRI revealed a Chiari I malformation with an asymmetric herniation of the right tonsil. Surgical inspection of the lower cranial nerves through a suboccipital approach showed no vascular compromise. The patient was pain free for three months before the same symptoms recurred. MRI showed a persisting crowding at the level of the foramen magnum. A second intervention with extension of the suboccipital craniectomy and resection of the right tonsil achieved definitive pain relief. To our knowledge this is the fourth report of a glossopharyngeal neuralgia caused by a Chiari I malformation. Recurrence of the pain after incomplete decompression of the posterior fossa underlines the importance of tonsillectomy in these patients.
一位 34 岁女性因右侧舌咽神经痛而就诊。MRI 显示 Chiari I 畸形，右侧扁桃体不对称疝出。通过枕下入路对颅神经进行手术检查，未见血管受压。患者在出现相同症状前三个月一直没有疼痛。MRI 显示枕骨大孔水平仍有持续的拥挤。第二次手术采用枕下入路延长颅颈减压术，并切除右侧扁桃体，从而达到了明确的止痛效果。据我们所知，这是第四例由 Chiari I 畸形引起的舌咽神经痛病例。在不完全减压后疼痛复发，强调了在这些患者中扁桃体切除术的重要性。
