Palanisamy Dhivya, Kyosuke Miyatani, Yasuhiro Yamada, Tsukasa Kawase, Kato Yoko
Department of Neurosurgery, Sri Narayani Hospital and Research Center, Neurosurgery, Sripuram, Vellore, Tamil Nadu, India.
Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Aichi, Japan.
World Neurosurg. 2018 Sep;117:339-343. doi: 10.1016/j.wneu.2018.06.136. Epub 2018 Jun 28.
Glossopharyngeal neuralgia (GPN) is a rare condition, commonly misdiagnosed as trigeminal neuralgia. Microvascular decompression (MVD) is considered the first line of treatment in medically refractive idiopathic GPN, and the recurrence rate is reported to be 7.1%. We present our first case report on the surgical management of a patient with recurrent GPN and analyze the possible causes for recurrence after MVD.
A 73-year-old gentleman was referred to us with a diagnosis of recurrent left GPN. He was diagnosed 6 years ago with left mandibular branch trigeminal neuralgia for the complaint of left-side tongue pain. He received left mandibular nerve block twice earlier and Gamma Knife radiotherapy 2 years ago without relief. A year ago he was diagnosed with GPN by a neurosurgeon, and MVD was performed. The posterior inferior cerebellar artery and vertebral artery were the offending vessels and were interposed with Teflon. After a temporary pain relief, the patient had a recurrence. Redo-MVD with transposition of the vertebral artery and further interposition of posterior inferior cerebellar artery did not help. After referral to us, we operated on the patient again and found 2 small arteries at the root entry zone (REZ). Interposition with Teflon and splitting of the rootlets relieved the pain.
MVD is considered the first line of treatment in drug-resistant idiopathic GPN. Thorough exploration of REZ for small arteries and veins is mandatory to prevent recurrence. Vascular compression can occur at the cisternal portion or at the REZ. In recurrent cases, splitting of the glossopharyngeal nerve rootlets adds to the good outcome.
舌咽神经痛（GPN）是一种罕见疾病，常被误诊为三叉神经痛。微血管减压术（MVD）被认为是药物难治性特发性GPN的一线治疗方法，据报道其复发率为7.1%。我们首次报告了一例复发性GPN患者的手术治疗情况，并分析了MVD术后复发的可能原因。
一名73岁男性因复发性左侧GPN被转诊至我院。他6年前因左侧舌痛被诊断为左侧下颌支三叉神经痛。他此前曾接受过两次左侧下颌神经阻滞，两年前接受过伽玛刀放射治疗，但均无缓解。一年前，一名神经外科医生诊断他患有GPN，并进行了MVD。小脑后下动脉和椎动脉是肇事血管，已用特氟龙进行了隔离。在疼痛暂时缓解后，患者复发。再次进行MVD，将椎动脉移位并进一步隔离小脑后下动脉均无效果。转诊至我院后，我们再次对该患者进行手术，在神经根入区（REZ）发现了2条小动脉。用特氟龙进行隔离并分离神经根缓解了疼痛。
MVD被认为是耐药性特发性GPN的一线治疗方法。必须对REZ进行全面探查以寻找小动脉和静脉，以防止复发。血管压迫可发生在脑池段或REZ。在复发病例中，分离舌咽神经根可取得良好效果。
