Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
World Neurosurg. 2020 Jul;139:314-317. doi: 10.1016/j.wneu.2020.04.130. Epub 2020 Apr 25.
Glossopharyngeal neuralgia/neuropathy is rare, and less than 3% of cases involve cardiac arrhythmias of syncope due to activated vagal reflex pathways. Most of these cases are successfully treated with medical management with or without pacemaker placement. We present the first reported case of glossopharyngeal neuralgia/neuropathy with cardiac symptoms refractory to medical management including pacemaker placement but successfully treated with Gamma Knife Radiosurgery.
A 70-year-old Caucasian man with recurrent squamous cell carcinoma of the tongue base treated with multiple surgeries, lymph node excision, chemotherapy, and external beam radiation, developed episodes of severe right ear and throat pain. These episodes would be followed by syncopal episodes associated with hypotension and bradycardia. Aggressive medical management including pacemaker could not stabilize the patient's hemodynamic instability. After extensive workup, the patient was diagnosed with glossopharyngeal neuralgia/neuropathy with associated carotid sinus instability. The patient was not a strong surgical candidate, thus the patient underwent Gamma Knife Radiosurgery. The target was set as the glossopharyngeal meatus. Within days of treatment, the patient had no further clinically significant syncope or hemodynamic instability for the remaining 6 months of his life.
To our knowledge, we present the first case of glossopharyngeal neuralgia/neuropathy with medically refractory cardiac dysfunction successfully treated with Gamma Knife Radiosurgery. We advocate that Gamma Knife be considered for similar subsets of patients.
舌咽神经痛/神经病很少见，不到 3%的病例因迷走神经反射途径激活而导致心律失常晕厥。这些病例大多数通过药物治疗（包括起搏器植入）或不治疗都可以成功治疗。我们报告首例舌咽神经痛/神经病伴有心脏症状，对药物治疗（包括起搏器植入）有反应，但通过伽玛刀放射外科手术成功治疗。
一名 70 岁白人男性，舌根复发性鳞状细胞癌，经多次手术、淋巴结切除、化疗和外照射治疗，出现严重右侧耳痛和咽痛发作。这些发作后会出现晕厥发作，伴有低血压和心动过缓。积极的药物治疗（包括起搏器）也不能稳定患者的血流动力学不稳定。经过广泛的检查，患者被诊断为舌咽神经痛/神经病伴颈动脉窦不稳定。患者不是手术的理想人选，因此患者接受了伽玛刀放射外科手术。目标设定为舌咽神经管。治疗后几天内，患者在生命的最后 6 个月内再未出现临床显著的晕厥或血流动力学不稳定。
据我们所知，我们报告了首例经药物治疗无效的心脏功能障碍的舌咽神经痛/神经病成功治疗的病例，使用伽玛刀放射外科手术。我们主张对类似的患者亚群考虑使用伽玛刀。
