Alafaci Concetta, Granata Francesca, Cutugno Mariano, Marino Daniele, Conti Alfredo, Tomasello Francesco
Department of Neurosurgery, University of Messina, Messina, Italy.
Department of Neuroradiology, University of Messina, Messina, Italy.
Surg Neurol Int. 2015 Feb 4;6:19. doi: 10.4103/2152-7806.150810. eCollection 2015.
Glossopharyngeal neuralgia (GN) is a rare condition characterized by severe, paroxysmal episodes of pain mainly localized to the external ear canal, pharynx, and tongue, usually caused by a neurovascular conflict between postero-inferior cerebellar artery (PICA) and IX cranial nerve. Sometimes there is also a compression of X c.n.
We present a case of a 71-year-old female with a 3-year history of intense pain localized in the pharynx and posterior portion of the tongue. Preoperative magnetic resonance imaging (MRI) documented a neurovascular conflict between a loop of PICA and IX left c.n. Surgery was performed through a retrosigmoid craniectomy. The intraoperative findings documented a loop of PICA compressing IX, X, and XI c.n. Microvascular decompression (MVD) of IX c.n. was performed using the interposing technique. No rhizotomy and MVD of the X c.n. was performed. Postoperative course showed the regression of all symptoms.
The surgical treatment of patients with GN caused by complex neurovascular conflicts can be safely performed with the classical MVD of IX c.n. A double MVD of both IX and X c.n. has a role only in patients presenting symptoms from both nerves. Rhizotomy, in our opinion, has to be avoided in all cases. The authors review the literature concerning GN caused by complex neurovascular conflicts.
舌咽神经痛（GN）是一种罕见疾病，其特征为主要局限于外耳道、咽部和舌部的严重阵发性疼痛发作，通常由小脑后下动脉（PICA）与第九颅神经之间的神经血管冲突引起。有时第十颅神经也会受压。
我们报告一例71岁女性，有3年咽部和舌后部剧痛病史。术前磁共振成像（MRI）显示PICA袢与左侧第九颅神经之间存在神经血管冲突。通过乙状窦后开颅术进行手术。术中发现记录显示PICA袢压迫第九、第十和第十一颅神经。采用置入技术对第九颅神经进行微血管减压（MVD）。未对第十颅神经进行切断术和MVD。术后病程显示所有症状均消退。
由复杂神经血管冲突引起的GN患者的手术治疗可通过经典的第九颅神经MVD安全进行。第九和第十颅神经的双重MVD仅对出现来自两条神经症状的患者有作用。我们认为，在所有情况下都应避免切断术。作者回顾了有关由复杂神经血管冲突引起的GN的文献。
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