University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Department of Radiology, Pittsburgh, Pennsylvania, USA.
J Neuroimaging. 2018 Sep;28(5):477-482. doi: 10.1111/jon.12554. Epub 2018 Aug 13.
Glossopharyngeal neuralgia causes extreme paroxysmal pain in the posterior pharynx, tonsillar region, base of tongue, or deep ear, that is, the distribution of the glossopharyngeal nerve. Some cases of glossopharyngeal neuralgia are associated with neurovascular conflict, usually by the posterior inferior cerebellar artery. Such symptomatic compression occurs only in proximal, centrally myelinated portions of the glossopharyngeal nerve near the brainstem. Microvascular decompression provides effective and durable pain relief for properly selected patients with medically refractory glossopharyngeal neuralgia. The purpose of this study is to describe a tailored MRI evaluation of neurovascular conflict in glossopharyngeal neuralgia to improve candidate selection for microvascular decompression.
Our team developed a glossopharyngeal neuralgia imaging and evaluation protocol including a grading system for neurovascular conflict of the glossopharyngeal nerve and applied it to evaluate candidates for microvascular decompression.
Our team grades neurovascular conflict as "contact" (vessel touching nerve without intervening cerebrospinal fluid) versus "deformation" (deviation or distortion of nerve from its normal course by the offending vessel). MRIs of patients with glossopharyngeal neuralgia demonstrate proximal neurovascular conflict. Postoperative MRI demonstrates separation of the glossopharyngeal nerve from the offending vessel.
A tailored glossopharyngeal neuralgia imaging evaluation protocol is presented. We believe this approach has helped improve microvascular decompression outcomes and reduce unnecessary procedures at our institution. Further research may elucidate whether clinical and imaging features, including neurovascular conflict severity, predict surgical outcome for glossopharyngeal neuralgia.
舌咽神经痛会导致后咽部、扁桃体区、舌根部或深部耳痛，即舌咽神经的分布区域。一些舌咽神经痛与神经血管冲突有关，通常由小脑后下动脉引起。这种有症状的压迫仅发生在靠近脑干的舌咽神经近端、中央有髓鞘的部分。微血管减压术为经过适当选择的、药物难治性舌咽神经痛患者提供了有效且持久的疼痛缓解。本研究旨在描述一种针对舌咽神经痛神经血管冲突的定制 MRI 评估方法，以改善微血管减压术的候选者选择。
我们的团队开发了一种舌咽神经痛成像和评估方案，包括舌咽神经神经血管冲突的分级系统，并将其应用于微血管减压术的候选者评估。
我们的团队将神经血管冲突分级为“接触”（血管接触神经但无中间脑脊液）与“变形”（病变血管使神经偏离正常走行）。舌咽神经痛患者的 MRI 显示近端神经血管冲突。术后 MRI 显示舌咽神经与致病血管分离。
提出了一种定制的舌咽神经痛成像评估方案。我们相信，这种方法有助于改善微血管减压术的结果，并减少我们机构的不必要手术。进一步的研究可能阐明临床和影像学特征，包括神经血管冲突的严重程度，是否可预测舌咽神经痛的手术结果。
