Blue Rachel, Spadola Michael, McAree Michael, Kvint Svetlana, Lee John Y K
Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA.
Department of Neurosurgery, Rowan School of Osteopathic Medicine, Philadelphia, USA.
Cureus. 2020 Dec 29;12(12):e12353. doi: 10.7759/cureus.12353.
Glossopharyngeal neuralgia (GN) is a nerve compression syndrome that presents with episodes of unilateral sharp, stabbing pain in the distribution of the ninth cranial nerve. This syndrome may present with cardiac and autonomic manifestations - a condition termed vagoglossopharyngeal neuralgia (VGPN). Most cases of VGPN arise from neurovascular insult at the cerebellopontine angle. Conservative treatment for VGPN includes antiepileptic medications. Surgical treatments include trigeminal tractotomy-nucleotomy, Gamma Knife® stereotactic radiosurgery, radiofrequency thermocoagulation, rhizotomy, and, as shown in this paper, endoscopic microvascular decompression (E-MVD). In this article, we present two cases. Case 1 demonstrates a 53-year-old male with right-sided GN symptoms that began to experience syncopal episodes 10-years after the initial presentation. Case 2 presents a 61-year-old female with a history of Ehlers-Danlos syndrome, and the malignant vasovagal syndrome that became associated with painful, shooting left anterior neck spasms consistent with GN. Both patients underwent E-MVD, leading to complete relief of neuralgia and cardiac symptoms. Our outcomes support previously published reports of successful treatment of VGPN using microvascular decompression (MVD) and describe a purely endoscopic surgical technique. MVD is the preferred treatment option for VGPN with evident neurovascular insult.
舌咽神经痛（GN）是一种神经压迫综合征，表现为第九颅神经分布区域内单侧尖锐、刺痛性疼痛发作。该综合征可能伴有心脏和自主神经表现，这种情况被称为迷走舌咽神经痛（VGPN）。大多数VGPN病例源于小脑脑桥角的神经血管损伤。VGPN的保守治疗包括抗癫痫药物。手术治疗包括三叉神经束切断术 - 核切断术、伽玛刀®立体定向放射外科手术、射频热凝术、神经根切断术，以及如本文所示的内镜下微血管减压术（E - MVD）。在本文中，我们展示了两个病例。病例1为一名53岁男性，右侧GN症状初发10年后开始出现晕厥发作。病例2为一名61岁女性，有埃勒斯 - 当洛综合征病史，出现与GN相符的左侧颈部前侧疼痛性、射痛性痉挛相关的恶性血管迷走性综合征。两名患者均接受了E - MVD，神经痛和心脏症状完全缓解。我们的结果支持先前发表的关于使用微血管减压术（MVD）成功治疗VGPN的报告，并描述了一种纯内镜手术技术。对于有明显神经血管损伤的VGPN，MVD是首选的治疗选择。
