Katoh Masahito, Aida Toshimitsu, Moriwaki Takuya, Yoshino Masami, Aoki Takeshi, Abumiya Takeo, Imamura Hiroyuki, Ogata Akihiko
Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Hokkaido, Japan.
No Shinkei Geka. 2012 Jun;40(6):533-7.
It is well-known that idiopathic neuralgias of the trigeminal and glossopharyngeal nerves are caused by vascular compression at the root entry zone of the cranial nerves. Because they are functional diseases, initial treatment is medical, especially with carbamazepine. However, if medical therapy fails to adequately manage the pain, microvascular decompression (MVD) is prescribed. Glossopharyngeal neuralgia is rare, and combined trigeminal and glossopharyngeal neuralgia is an extremely rare disorder. A 70-year-old woman presented herself to Hokkaido Neurosurgical Memorial Hospital because of paroxysms of lancinating pain in her left pharynx and another lancinating pain in her left cheek. Carbamazepine, which was prescribed at another hospital, favorably relieved the pain; however, drug eruption compelled her to discontinue the medication. The multi-volume method revealed that a root entry zone of the left glossopharyngeal nerve was compressed by the left posterior inferior cerebellar artery, and the left trigeminal artery was compressed by the left superior cerebellar artery. MVD for both nerves was performed employing a left lateral suboccipital craniotomy. She experienced complete relief of pain immediately after MVD. Combined trigeminal and glossopharyngeal neuralgia is extremely rare, but some groups noted a relatively high incidence of concurrent trigeminal neuralgia in patients with glossopharyngeal neuralgia up until the 1970's. Glossopharyngeal neuralgia includes pain near the gonion; therefore, there is an overlap of symptoms between glossopharyngeal and trigeminal neuralgias. By virtue of recent progress in imaging technology, minute preoperative evaluations of microvascular compression are possible. Until the 1970's, there might have been some misunderstanding regarding the overlap of symptoms because of lack of the concept of microvascular compression as a cause of neuralgia and rudimentary imaging technology. Minute evaluations of both symptoms and imaging are very important.
众所周知，三叉神经和舌咽神经的特发性神经痛是由颅神经根部进入区的血管压迫所致。由于它们是功能性疾病，初始治疗为药物治疗，尤其是使用卡马西平。然而，如果药物治疗不能充分控制疼痛，则会采用微血管减压术（MVD）。舌咽神经痛较为罕见，而三叉神经和舌咽神经联合性神经痛则极为罕见。一名70岁女性因左侧咽部阵发性刺痛和左侧面颊另一处刺痛就诊于北海道神经外科纪念医院。在另一家医院开具的卡马西平有效缓解了疼痛；然而，药物疹迫使她停药。多容积法显示，左侧舌咽神经根部进入区被左小脑后下动脉压迫，左侧三叉神经被左小脑上动脉压迫。采用左侧枕下开颅术对两条神经进行了微血管减压术。微血管减压术后她立即疼痛完全缓解。三叉神经和舌咽神经联合性神经痛极为罕见，但一些研究小组指出，直到20世纪70年代，舌咽神经痛患者并发三叉神经痛的发生率相对较高。舌咽神经痛包括下颌角附近的疼痛；因此，舌咽神经痛和三叉神经痛之间存在症状重叠。由于成像技术的最新进展，术前对微血管压迫进行细致评估成为可能。直到20世纪70年代，由于缺乏微血管压迫作为神经痛病因的概念以及成像技术不完善，可能对症状重叠存在一些误解。对症状和成像进行细致评估非常重要。
