Continuous radiofrequency thermocoagulation under CT-guidance for glossopharyngeal neuralgia: Two case reports.

RATIONALE

Glosssopharyngeal neuralgia (GPN) is a painful syndrome characterized by paroxysmal neuropathic pain in the pharynx, tonsil, posterior base of tongue, inner ear, and mandibular angle. The traditional therapies of GPN, including medication and surgical operation, are not always effective in pain controlling. Radiofrequency therapy is a minimally interventional technique to provide analgesia in chronic pain.

PATIENT CONCERNS

Two patients who were refractory to medical treatment were hospitalized for primary GPN.

DIAGNOSES

Two patients were diagnosed by symptoms, physical signs and imaging examination.

INTERVENTIONS

The first patient underwent pulsed radiofrequency of the glossopharyngeal nerve under CT-guidance as a preferred method. The pulsed radiofrequency (PRF) was performed at 42°C for 10 minutes with a pulsed frequency of 2 Hz and a pulse width 20 ms. There is no symptom improvement after PRF procedure. Three days later, continuous radiofrequency (CRF) thermocoagulation was performed. The pain disappeared after CRF within 36 months followed-up. CRF thermocoagulation under CT-guidance was accepted by the second patient as the first choice.

OUTCOMES

An overall reduction of pain was reported after the procedure and telephone consult for 24-months follow-up confirmed the persistence of the pain relief.

LESSONS

The CRF thermocoagulation produced no complications or side effects in the two cases, and was proved effective in the treatment of GPN.