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Wu Z, Zhao Y, Wu F, Fan Y, Yang Y. Percutaneous radiofrequency thermocoagulation and microvascular decompression for treating glossopharyngeal neuralgia: a retrospective clinical study. BMC Neurol 2023; 23:384. [PMID: 37872489 PMCID: PMC10591372 DOI: 10.1186/s12883-023-03415-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/30/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the differences in the effectiveness of percutaneous radiofrequency thermocoagulation (PRT) and microvascular decompression (MVD) in treating glossopharyngeal neuralgia (GPN). METHODS Medical records of patients were reviewed to investigate their baseline characteristics and immediate postoperative prognosis. Long-term outcomes of these patients were obtained through telephone interviews. Visual analog scale (VAS) and Pittsburgh sleep quality index (PSQI) scores at 1 day and 1, 4, 12, 24, and 48 weeks after surgery were compared between the MVD and PRT groups, in addition to complete pain relief rate, effective rate, adverse reactions, length of hospital stay, and economic indicators. RESULTS The VAS and PSQI scores of the two groups at 1 day and 1, 4, 12, 24, and 48 weeks after surgery were significantly lower (P < 0.05) than those before surgery. At 48 weeks, the complete remission rate was significantly higher (P < 0.05) in the MVD group than in PRT group. No significant difference in adverse reactions was observed between the two groups. The length of hospital stay, operative time, and cost were significantly higher (P < 0.05) in the MVD group than in the PRT group. CONCLUSIONS Both PRT and MVD can significantly reduce patients' degree of pain and improve their sleep quality. In the medium term, MVD is better than PRT in terms of the complete curative effect. In young patients with GPN, MVD is more often recommended than PRT; however, MVD is costlier than PRT.
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Affiliation(s)
- Zeyu Wu
- Department of Pain,The Affiliated Nanchong Central Hospital of North Sichuan Medical College, 97, South Renmin Road, Shunqing District, Nanchong, Sichuan, China
| | - Yongming Zhao
- Department of Pain,The Affiliated Nanchong Central Hospital of North Sichuan Medical College, 97, South Renmin Road, Shunqing District, Nanchong, Sichuan, China
| | - Fan Wu
- Department of Pharmacy, Sichuan Nanchong Mental Health center, The Second People's Hospital of Nanchong, Nanchong, Sichuan, China
| | - Yiyue Fan
- Department of Pain,The Affiliated Nanchong Central Hospital of North Sichuan Medical College, 97, South Renmin Road, Shunqing District, Nanchong, Sichuan, China.
| | - Ying Yang
- Department of Pain,The Affiliated Nanchong Central Hospital of North Sichuan Medical College, 97, South Renmin Road, Shunqing District, Nanchong, Sichuan, China.
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Abougamil AB, Metwaly TI, Deif OA, Khedr W. Sling technique in microvascular decompression surgery for trigeminal neuralgia: early experience and functional outcomes. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-022-00183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Abstract
Background
Trigeminal neuralgia (TGN) is a facial pain disorder often caused by arterial compression of the trigeminal nerve. Microvascular decompression (MVD) remains the most definitive treatment for this disorder, with a reported cure rate between 60 and 80%. MVD techniques often involve a retrosigmoid craniotomy with placement of an inert foreign material, such as Gore-Tex or Teflon, between the nerve and the compressing vessel.
Recurrence of TGN after MVD has been associated with vessel migration and adhesion formation. In this study, we tested the use of Gore-Tex sling, fixed in place with fibrin glue to displace the compressing vessel away from the nerve.
Results
This is a retrospective study including 20 patients who had an MVD for treatment of idiopathic TGN where a sling of Gore-Tex was used with the application of fibrin glue to prevent dislocation of the vessel. It showed that sling MVD technique is an effective method for treatment of classic trigeminal neuralgia. Eighteen patients improved within 2 weeks postoperatively. One patient had recurrence of symptoms and was reoperated 1 year later.
Conclusion
Gore-Tex slinging technique is a safe simple technique for preventing re-dislocation of the offending vessel and thus recurrence of symptoms. However, larger series is needed to judge on the long-term efficacy and safety of this technique.
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Inoue K, Matsushima T, Ohara S, Masuoka J, Abe T. Study of the Anatomical Features of the Offending Arteries Involved in Glossopharyngeal Neuralgia. Oper Neurosurg (Hagerstown) 2020; 19:E259-E268. [PMID: 31960063 DOI: 10.1093/ons/opz425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/01/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The anatomic features of the posterior inferior cerebellar arteries (PICAs) and the anterior inferior cerebellar arteries (AICAs) as offending arteries involved in glossopharyngeal neuralgia (GPN) are important to dictate the best surgical approach. OBJECTIVE To study and classify the anatomic features of the offending arteries. METHODS All clinical data and surgical videos from 18 GPN cases that were surgically treated during the past 10 yr were retrospectively reviewed. RESULTS Among these 18 patients, the offending arteries involved were the PICA in 12 (66.7%), AICA in 4 (22.2%), and both PICA and AICA in 2 (11.1%). The PICA were then classified into the following groups based on their anatomic features: type I: the PICA formed an upward loop at the level of the glossopharyngeal nerve and passed between the glossopharyngeal and vestibulocochlear nerves; type II: the PICA formed an upward loop at the level of the glossopharyngeal nerve and passed between the glossopharyngeal and vagus nerves or between the rootlets of the vagus nerve; and type III: the PICA passed between the glossopharyngeal and vestibulocochlear nerves without forming a loop. The AICA had only one running pattern. CONCLUSION The offending arteries involved in GPN, mainly the PICA and/or AICA, were classified into 4 different types based on their anatomic features.
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Affiliation(s)
- Kohei Inoue
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Toshio Matsushima
- Graduate School, International University of Health and Welfare, Fukuoka, Japan.,Neuroscience Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Shinji Ohara
- Graduate School, International University of Health and Welfare, Fukuoka, Japan.,Neuroscience Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Jun Masuoka
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tatsuya Abe
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
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Matsushima T, Matsushima K, Kobayashi S, Lister JR, Morcos JJ. The microneurosurgical anatomy legacy of Albert L. Rhoton Jr., MD: an analysis of transition and evolution over 50 years. J Neurosurg 2018; 129:1331-1341. [PMID: 29393756 DOI: 10.3171/2017.7.jns17517] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/13/2017] [Indexed: 11/06/2022]
Abstract
The authors chronologically categorized the 160 original articles written by Dr. Rhoton and his fellows to show why they selected their themes and how they carried out their projects. The authors note that as neurosurgery progresses and new techniques and approaches are developed, accurate and safe treatment will depend upon continued clarification of microsurgical anatomy.
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Affiliation(s)
- Toshio Matsushima
- 1International University of Health and Welfare
- 2Neuroscience Center, Fukuoka Sanno Hospital, Fukuoka
| | - Ken Matsushima
- 3Department of Neurosurgery, Tokyo Medical University, Tokyo
| | - Shigeaki Kobayashi
- 4Medical Research and Education Center, Aizawa Hospital, Matsumoto, Japan
| | - J Richard Lister
- 5Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville; and
| | - Jacques J Morcos
- 6Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Lu VM, Goyal A, Graffeo CS, Perry A, Jonker BP, Link MJ. Glossopharyngeal Neuralgia Treatment Outcomes After Nerve Section, Microvascular Decompression, or Stereotactic Radiosurgery: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:572-582.e7. [PMID: 30240868 DOI: 10.1016/j.wneu.2018.09.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Glossopharyngeal neuralgia (GPN) is a rare neuralgic pain syndrome amenable to neurosurgical treatments, including nerve section (NS), microvascular decompression (MVD), and stereotactic radiosurgery (SRS). However, thorough comparisons of the modalities have not been performed to date. The objective of the present study was to compare the pain and complication outcomes after these approaches to GPN. METHODS Searches of 7 electronic databases from inception to June 2018 were conducted following the appropriate guidelines. The incidence rates (IRs) of short-term (≤3 months) and long-term (≥12 months) pain relief and complications were extracted and analyzed using a meta-analysis. Meta-regression was used to assess for heterogeneity. RESULTS A total of 792 GPN cases managed by NS, MVD, or SRS were described by 6, 11, and 6 studies, reporting outcomes for 282 (36%), 446 (56%), and 67 (8%) cases. The short-term pain relief rate was highest after NS postoperatively (IR, 94%; 95% confidence interval [CI], 88%-98%) and lowest after SRS at 3 months postoperatively (IR, 80%; 95% CI, 68%-96%). The postoperative complication rate was greatest after MVD (IR, 26%; 95% CI, 16%-38%) and lowest after SRS (IR, 0%; 95% CI, 0%-4%). The long-term pain relief rate was greatest after NS (IR, 96%; 95% CI, 91%-99%) and lowest after SRS (IR, 82%; 95% CI, 67%-94%). Statistically significant differences between the approaches were found for each outcome. CONCLUSION Neurosurgical treatment of GPN is frequently performed by 1 of 3 modalities with unique outcomes profiles. NS might provide the most favorable treatment response, with respect to short- and long-term pain relief and postoperative outcomes.
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Affiliation(s)
- Victor M Lu
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
| | - Anshit Goyal
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Avital Perry
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin P Jonker
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Michael J Link
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Microvascular decompression for glossopharyngeal neuralgia: a retrospective analysis of 228 cases. Acta Neurochir (Wien) 2018; 160:117-123. [PMID: 29103137 DOI: 10.1007/s00701-017-3347-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Glossopharyngeal neuralgia (GPN) is an uncommon craniofacial pain syndrome caused by neurovascular conflict. Compared to trigeminal neuralgia or hemifacial spasm, the incidence of GPN was very low. Until now, little is known about the long-term outcome following microvascular decompression (MVD) process. METHODS Between 2006 and 2016, 228 idiopathic GPN patients underwent MVD in our department. Those cases were retrospectively reviewed with emphasis on intraoperative findings and long-term postoperative outcomes. The average period of follow-up was 54.3 ± 6.2 months. RESULTS Intraoperatively, the culprit was identified as the posterior inferior cerebellar artery (PICA) in 165 cases (72.3%), the vertebral artery (VA) in 14 (6.1%), vein in 10 (4.4%), and a combination of multiple arteries or venous offending vessels in 39 (17.2%). The immediately postoperative outcome was excellent in 204 cases (89.5%), good in 12 (5.3%), fair in 6 (2.6%) and poor in 6 (2.6%). More than 5-year follow-up was obtained in 107 cases (46.9%), which presented as excellent in 93 (86.9%), good in 6 (5.6%), fair in 3 (2.8%) and poor in 5 (4.7%). Thirty-seven (16.2%) of the patients experienced some postoperative neurological deficits immediately, such as dysphagia, hoarseness and facial paralysis, which has been improved at the last follow-up in most cases, except 2. CONCLUSIONS This investigation demonstrated that MVD is a safe and effective remedy for treatment of GPN.
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Ota N, Tanikawa R, Yoshikane T, Miyama M, Miyazaki T, Kinoshita Y, Matsukawa H, Yanagisawa T, Sakakibara F, Suzuki G, Saito N, Miyata S, Noda K, Tsuboi T, Takeda R, Kamiyama H, Tokuda S, Kamada K. Surgical Microanatomy of the Posterior Condylar Emissary Vein and its Anatomical Variations for the Transcondylar Fossa Approach. Oper Neurosurg (Hagerstown) 2017; 13:382-391. [PMID: 28521354 DOI: 10.1093/ons/opw038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/14/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is essential to identify and be aware of the anatomy of the posterior condylar emissary vein (PCEV) for achieving an adequate operative field for the transcondylar fossa approach (TCFA). OBJECTIVE To describe the variations in the drainage patterns of PCEVs and the technical issues encountered in such cases. METHODS This was a retrospective analysis of the anatomy of PCEVs in 104 sides in 52 cases treated by the TCFA. Preoperative findings of multidetector-row computed tomography (CT) and CT venography (CTV) were compared with the intraoperative findings. The drainage patterns were classified as 5 types: the sigmoid sinus (SS), jugular bulb (JB), occipital sinus (OS), anterior condylar emissary vein (ACEV), and marginal sinus (MS). RESULTS The SS, JB, ACEV, and OS types were observed in 33 (31.7%), 42 (40.3%), 8 (7.7%), and 1 (1.0%) side(s), respectively. One side (1.0%) each had combined drainage from MS and JB, and ACEV and JB, respectively. In 17 sides (16.3%), the PCEVs and posterior condylar canals could not be identified on CT and CTV. CONCLUSIONS Preoperative CT and CTV findings correlated well with the intraoperative findings. To make a sufficient operative field for TCFA, PCEVs should be appropriately dealt with based on the preoperative knowledge of their running course, pattern, and origin.
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Affiliation(s)
- Nakao Ota
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Tsutomu Yoshikane
- Department of Neuro-surgery, Shimane University School of Medicine, Matsue, Japan
| | - Masataka Miyama
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Takanori Miyazaki
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Yu Kinoshita
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hidetoshi Matsukawa
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Takeshi Yanagisawa
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Fumihiro Sakakibara
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Go Suzuki
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Norihiro Saito
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Shiro Miyata
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Toshiyuki Tsuboi
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Rihei Takeda
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Sadahisa Tokuda
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kyousuke Kamada
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
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8
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Vago-glossopharyngeal neuralgia: a literature review of neurosurgical experience. Acta Neurochir (Wien) 2015; 157:311-21; discussion 321. [PMID: 25526720 DOI: 10.1007/s00701-014-2302-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
Glossopharyngeal neuralgia (GPN), or better named vago-glossopharyngeal neuralgia (VGPN), is a rare disorder amounting to 1 % of the incidence of trigeminal neuralgia (TN). Pain is paroxysmal, of the electrical shooting type, and mainly provoked by stimulation of the pharynx or deep throat, especially during swallowing. Due to its rarity, VGPN is often misdiagnosed. The front line of medical treatment is based on anticonvulsants. Surgery should be considered when the pain is refractory to medications. In most patients, the cause is neurovascular conflict on root entry zone (REZ) or midcistern portion, of the IXth and/or Xth cranial nerves. Compressive vessels can be evidenced by means of a high sensibility and a high specificity resolution MR imaging in most centers. Present consensus is that the first option of neurosurgical treatment be microvascular decompression. In patients with precarious general conditions, stereotactic radiosurgery may be considered. Also, thermo-rhizotomy at the pars nervosa of foramen jugularis or tractotomy-nucleotomy at brainstem may be alternatives, but these methods entail a significant risk of deficits. In this article, the authors reviewed the main literature series on neurosurgical treatments of this disease.
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Kim YD, Mendes GAC, Seoane P, Agrawal A, Maramreddy N, Nakaji P, Spetzler RF, Preul MC. Quantitative Anatomical Study of Tailored Far-Lateral Approach for the VA-PICA Regions. J Neurol Surg B Skull Base 2014; 76:57-65. [PMID: 25685651 DOI: 10.1055/s-0034-1389373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 06/14/2014] [Indexed: 10/24/2022] Open
Abstract
Objective The extent of the far-lateral approach (FLA) has not yet been quantified for the region of the vertebral and posterior inferior cerebellar arteries (VA-PICA). We quantitatively analyzed six main sequential steps of the FLA. Methods A modified small FLA (msFLA) and a classic large FLA (clFLA) were performed sequentially on both sides of five cadaveric heads. A frameless navigational system was used to quantify the angle of attack for the origin (T1) and lateral medullary segment (T2) of the PICA and the surgical area of exposure above and below the vagus nerve (cranial nerve [CN] X). Results The total area of exposure above CN X increased significantly (p < 0.05) from the msFLA to the clFLA. However, the surgical exposure area below CN X did not change (p > 0.05). C1 hemilaminectomy increased (p < 0.05) the vertical angle of attack, and drilling the posteromedial third of the occipital condyle increased (p < 0.05) the horizontal angle of attack to the origin of the PICA. Conclusions For the VA-PICA region, the msFLA offered a similar practical surgical working area and similar angles of attack when compared with the clFLA. The FLA should be tailored based on the location, size, and pathology of lesions and on the exposure required for effective surgical treatment.
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Affiliation(s)
- Young-Don Kim
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States ; Department of Neurological Surgery, Daegu Catholic University Medical Center, Daegu, Korea
| | - George A C Mendes
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Pablo Seoane
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Abhishek Agrawal
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Naveen Maramreddy
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Peter Nakaji
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Robert F Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Mark C Preul
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
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Matsushima K, Kawashima M, Matsushima T, Hiraishi T, Noguchi T, Kuraoka A. Posterior condylar canals and posterior condylar emissary veins—a microsurgical and CT anatomical study. Neurosurg Rev 2013; 37:115-26. [DOI: 10.1007/s10143-013-0493-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 02/01/2013] [Accepted: 03/10/2013] [Indexed: 11/28/2022]
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Rey-Dios R, Cohen-Gadol AA. Current neurosurgical management of glossopharyngeal neuralgia and technical nuances for microvascular decompression surgery. Neurosurg Focus 2013; 34:E8. [PMID: 23451790 DOI: 10.3171/2012.12.focus12391] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Glossopharyngeal neuralgia (GPN) is an uncommon facial pain syndrome often misdiagnosed as trigeminal neuralgia. The rarity of this condition and its overlap with other cranial nerve hyperactivity syndromes often leads to a significant delay in diagnosis. The surgical procedures with the highest rates of pain relief for GPN are rhizotomy and microvascular decompression (MVD) of cranial nerves IX and X. Neurovascular conflict at the level of the root exit zone of these cranial nerves is believed to be the cause of this pain syndrome in most cases. Vagus nerve rhizotomy is usually reserved for cases in which vascular conflict is not evident. A review of the literature reveals that although the addition of cranial nerve X rhizotomy may improve the chances of long-term pain control, this maneuver also increases the risk of permanent dysphagia and vocal cord paralysis. The risks of this procedure have to be carefully weighed against its benefits. Based on the authors' experience, careful patient selection with a thorough exploratory operation most often leads to identification of the site of vascular conflict, obviating the need for cranial nerve X rhizotomy.
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Affiliation(s)
- Roberto Rey-Dios
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
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12
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Hiraishi T, Matsushima T, Kawashima M, Nakahara Y, Takahashi Y, Ito H, Oishi M, Fujii Y. 3D Computer graphics simulation to obtain optimal surgical exposure during microvascular decompression of the glossopharyngeal nerve. Neurosurg Rev 2013; 36:629-35; discussion 635. [PMID: 23771632 DOI: 10.1007/s10143-013-0479-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 01/01/2013] [Accepted: 03/10/2013] [Indexed: 12/01/2022]
Abstract
The affected artery in glossopharyngeal neuralgia (GPN) is most often the posterior inferior cerebellar artery (PICA) from the caudal side or the anterior inferior cerebellar artery (AICA) from the rostral side. This technical report describes two representative cases of GPN, one with PICA as the affected artery and the other with AICA, and demonstrates the optimal approach for each affected artery. We used 3D computer graphics (3D CG) simulation to consider the ideal transposition of the affected artery in any position and approach. Subsequently, we performed microvascular decompression (MVD) surgery based on this simulation. For PICA, we used the transcondylar fossa approach in the lateral recumbent position, very close to the prone position, with the patient's head tilted anteriorly for caudal transposition of PICA. In contrast, for AICA, we adopted a lateral suboccipital approach with opening of the lateral cerebellomedullary fissure, to visualize better the root entry zone of the glossopharyngeal nerve and to obtain a wide working space in the cerebellomedullary cistern, for rostral transposition of AICA. Both procedures were performed successfully. The best surgical approach for MVD in patients with GPN is contingent on the affected artery--PICA or AICA. 3D CG simulation provides tailored approach for MVD of the glossopharyngeal nerve, thereby ensuring optimal surgical exposure.
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Affiliation(s)
- Tetsuya Hiraishi
- Department of Neurosurgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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Kawashima M, Takase Y, Matsushima T. Surgical treatment for vertebral artery-posterior inferior cerebellar artery aneurysms: special reference to the importance of the cerebellomedullary fissure dissection. J Neurosurg 2012; 118:460-4. [PMID: 23176340 DOI: 10.3171/2012.10.jns12603] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The cerebellomedullary fissure (CMF) is a space between the cerebellum and the medulla oblongata, which often adhere to each other. The purpose of the present study was to demonstrate the importance of the unilateral CMF dissection for clipping vertebral artery (VA)-posterior inferior cerebellar artery (PICA) aneurysms. METHODS Five adult cadaveric specimens were studied after colored silicone was infused into the arteries and veins. The microsurgical anatomy of the CMF and the trans-CMF approach for VA-PICA aneurysm surgery were examined in stepwise dissections. In addition, 6 patients underwent surgery for VA-PICA saccular aneurysms (2 ruptured and 4 unruptured aneurysms) via posterolateral approaches, with wide opening of the unilateral CMF to obtain good visualization and a wide working space in the lateral part of the cerebellomedullary cistern. Clinical data including neurological and radiological findings and patient outcomes were analyzed in all 6 cases. RESULTS In all cases, the aneurysm was successfully clipped and no permanent neurological deficits remained. The wide opening of the unilateral CMF on the lesion side made it possible to retract the inferolateral part of the cerebellum easily, provided a wide operative field in the cerebellomedullary cistern, and enabled successful clip placement without difficulty. CONCLUSIONS For safe and effective VA-PICA aneurysm surgery, it is very important to dissect the CMF on the lesion side as well as to remove the lateral part of the foramen magnum. Direct clip placement is very safe and useful in cases involving VA-PICA aneurysms.
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Affiliation(s)
- Masatou Kawashima
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan.
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Matsushima T, Kawashima M, Masuoka J, Mineta T, Inoue T. Transcondylar fossa (supracondylar transjugular tubercle) approach: anatomic basis for the approach, surgical procedures, and surgical experience. Skull Base 2011; 20:83-91. [PMID: 20808532 DOI: 10.1055/s-0029-1242193] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The authors clarify the anatomic basis and the usefulness of the transcondylar fossa approach (T-C-F A), in which the posterior portion of the jugular tubercle is removed extradurally through the condylar fossa with the atlanto-occipital joint intact. The authors first performed an anatomic study to identify the area to be removed using cadaveric specimens and then applied the T-C-F A to foramen magnum surgeries. The surgeries included clipping a vertebral artery-posterior inferior cerebellar artery aneurysm in 11 cases, microvascular decompression for glossopharyngeal neuralgia in 15 cases, and removing intradural foramen magnum tumors in 17 cases. Only the condylar fossa was removed, but the approach offered very good visualization of the lateral part of the foramen magnum and sufficient working space. These surgeries were performed safely without major complications. This skull base approach is minimally invasive and is not difficult. Therefore, it can be a standard approach for accessing intradural lesions of the foramen magnum. It can be combined with the transcerebellomedullary fissure approach from the lateral side and can also be easily changed to the transcondylar approach, if necessary.
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Stitched sling retraction technique for microvascular decompression: procedures and techniques based on an anatomical viewpoint. Neurosurg Rev 2011; 34:373-9; discussion 379-80. [PMID: 21347661 DOI: 10.1007/s10143-011-0310-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 10/25/2010] [Accepted: 01/07/2011] [Indexed: 10/18/2022]
Abstract
The success of microvascular decompression (MVD) depends on the permanent and complete transposition of the offending vessels. This paper describes the stitched sling retraction techniques for treating trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GPN), focusing on the stitching point for slinging the offending artery in the appropriate direction. Between January 2007 and March 2009, 28 patients with TN, 5 patients with HFS, and 3 patients with GPN underwent MVD with a sling retraction technique. In cases of TN, MVD was performed using the infratentorial lateral supracerebellar approach, and the offending superior cerebellar artery was superomedially transposed with a sling stitched to the tentorium cerebelli. In cases of HFS, MVD was performed using the lateral suboccipital infrafloccular approach, and the offending vertebral artery was superolaterally transposed with a sling stitched to the petrous dura. In cases of GPN, MVD was performed using the transcondylar fossa approach, in which the posterior inferior cerebellar artery was inferolaterally mobilized with a sling secured to the jugular tubercle. No patient suffered recurrence in the follow-up period. For the sling retraction technique to be performed successfully, it is important for a stitch to be placed at a suitable site to sling the offending vessel in the intended direction. An appropriate surgical approach must be used to obtain a sufficient operative field for performing the stitching procedures safely.
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Kawashima M, Matsushima T, Inoue T, Mineta T, Masuoka J, Hirakawa N. Microvascular decompression for glossopharyngeal neuralgia through the transcondylar fossa (supracondylar transjugular tubercle) approach. Neurosurgery 2010; 66:275-80; discussion 280. [PMID: 20489516 DOI: 10.1227/01.neu.0000369662.36524.cf] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Our surgical results were reviewed to clarify the cause of glossopharyngeal neuralgia (GPN) and the effects of the microvascular decompression (MVD) procedure. METHODS Fourteen cases of idiopathic GPN were operated on through the transcondylar fossa (supracondylar transjugular tubercle) approach. Their clinical data and operative records were retrospectively reviewed. RESULTS In every case, vascular compression on the glossopharyngeal nerve was found and MVD was performed without any major complications. In 13 of the 14 cases the neuralgia completely disappeared postoperatively. Recurrence of pain was found in 1 case. Offending vessels were the posterior inferior cerebellar artery (PICA) in 10 cases, the anterior inferior cerebellar artery (AICA) in 2 cases, and both arteries in 2 cases. In 10 of the 14 cases, the high-origin PICA formed an upward loop between the glossopharyngeal and vagus nerves, compressing the glossopharyngeal nerve upward. In those cases, the PICA was transposed and fixed to the dura mater by the stitched sling retraction technique, and MVD was very effective. CONCLUSION The offending artery was the PICA in most cases. MVD is expected to be very effective, especially when the radiological images show the following 3 findings: 1) high-origin PICA, 2) the PICA making an upward loop, and 3) the PICA coursing the supraolivary fossette. The transcondylar fossa approach is suitable for transposing the PICA by the stitched sling retraction technique, and provides sufficient surgical results.
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Affiliation(s)
- Masatou Kawashima
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan.
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Kawashima M, Matsushima T, Nakahara Y, Takase Y, Masuoka J, Ohata K. Trans-cerebellomedullary fissure approach with special reference to lateral route. Neurosurg Rev 2009; 32:457-64. [PMID: 19609581 DOI: 10.1007/s10143-009-0211-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Revised: 02/19/2009] [Accepted: 04/14/2009] [Indexed: 11/24/2022]
Affiliation(s)
- Masatou Kawashima
- Department of Neurosurgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan.
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MRI of Glossopharyngeal Neuralgia Caused by Neurovascular Compression. AJR Am J Roentgenol 2008; 191:578-81. [PMID: 18647935 DOI: 10.2214/ajr.07.3025] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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HASEGAWA S, MORIOKA M, KAI Y, KURATSU JI. Usefulness of Balloon Test Occlusion in the Diagnosis of Glossopharyngeal Neuralgia -Case Report-. Neurol Med Chir (Tokyo) 2008; 48:163-6. [DOI: 10.2176/nmc.48.163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shu HASEGAWA
- Department of Neurosurgery, Kumamoto Red Cross Hospital
- Department of Neurosurgery, Kumamoto University School of Medicine
| | - Motohiro MORIOKA
- Department of Neurosurgery, Kumamoto University School of Medicine
| | - Yutaka KAI
- Department of Neurosurgery, Kumamoto University School of Medicine
| | - Jun-ichi KURATSU
- Department of Neurosurgery, Kumamoto University School of Medicine
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Phuong HL, Matsushima T, Hisada K, Matsumoto K. Glossopharyngeal neuralgia due to an epidermoid tumour in the cerebellopontine angle. J Clin Neurosci 2004; 11:758-60. [PMID: 15337142 DOI: 10.1016/j.jocn.2003.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2003] [Accepted: 07/02/2003] [Indexed: 11/17/2022]
Abstract
A 42-year-old female presented with typical glossopharyngeal neuralgia. Magnetic resonance imaging demonstrated an epidermoid tumour in the left cerebellopontine angle. Surgery showed that the tumour was compressing the glossopharyngeal nerve but no vessel was related to the nerve. The tumour was subtotally removed and after surgery the patient showed a complete relief of pain. This is a very rare case of glossopharyngeal neuralgia alone due to an epidermoid tumour.
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Affiliation(s)
- Huynh-Le Phuong
- Department of Neurosurgery, Neurological Institute, Graduate school of Medical Sciences, Kyushu University, Fukuoka, Japan
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Hitotsumatsu T, Matsushima T, Inoue T. Microvascular Decompression for Treatment of Trigeminal Neuralgia, Hemifacial Spasm, and Glossopharyngeal Neuralgia: Three Surgical Approach Variations: Technical Note. Neurosurgery 2003; 53:1436-41; discussion 1442-3. [PMID: 14633313 DOI: 10.1227/01.neu.0000093431.43456.3b] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
We have used three different approaches, namely, the infratentorial lateral supracerebellar approach, the lateral suboccipital infrafloccular approach, and the transcondylar fossa approach, for microvascular decompression for treatment of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia, respectively. Each approach is a variation of the lateral suboccipital approach to the cerebellopontine angle (CPA); however, each has a different site of bony opening, a different surgical direction, and a different route along the cerebellar surface.
METHODS
The infratentorial lateral supracerebellar approach is used to access the trigeminal nerve in the superior portion of the CPA through the lateral aspect of the cerebellar tentorial surface. The lateral suboccipital infrafloccular approach is directed through the inferior part of the cerebellar petrosal surface to reach the root exit zone of the facial nerve below the flocculus. The transcondylar fossa approach is used to access the glossopharyngeal nerve in the inferior portion of the CPA through the cerebellar suboccipital surface, after extradural removal of the jugular tubercle as necessary.
RESULTS
In all three approaches, the cerebellar petrosal surface is never retracted transversely, that is, the cerebellar retraction is never directed parallel to the longitudinal axis of the VIIIth cranial nerve, dramatically reducing the risk of postoperative hearing loss.
CONCLUSION
The greatest advantage of the differential selection of the surgical approach is increased ability to reach the destination in the CPA accurately, with minimal risk of postoperative cranial nerve palsy.
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Affiliation(s)
- Tsutomu Hitotsumatsu
- Department of Neurosurgery, Clinical Research Institute, National Kyushu Medical Center, Fukuoka, Japan.
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Matsushima T, Matsukado K, Natori Y, Inamura T, Hitotsumatsu T, Fukui M. Surgery on a saccular vertebral artery-posterior inferior cerebellar artery aneurysm via the transcondylar fossa (supracondylar transjugular tubercle) approach or the transcondylar approach: surgical results and indications for using two different lateral skull base approaches. J Neurosurg 2001; 95:268-74. [PMID: 11780897 DOI: 10.3171/jns.2001.95.2.0268] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors report on the surgical results they achieved in caring for patients with vertebral artery-posterior inferior cerebellar artery (VA-PICA) saccular aneurysms that were treated via either the transcondylar fossa (supracondylar transjugular tubercle) approach or the transcondylar approach. In this report they clarify the characteristics of and differences between these two lateral skull base approaches. They also present the techniques they used in performing the transcondylar fossa approach, especially the maneuver used to remove the jugular tubercle extradurally without injuring the atlantooccipital joint. METHODS Eight patients underwent surgery for VA-PICA saccular aneurysms (six ruptured and two unruptured ones) during which one of the two approaches was performed. Clinical data including neurological and radiological findings and reports of the operative procedures were analyzed. The Glasgow Outcome Scale was used to estimate the activities of daily living experienced by the patients. In all cases the aneurysm was successfully clipped and no permanent neurological deficits remained, except for one case of severe vasospasm. In seven of the eight patients, the transcondylar fossa approach provided a sufficient operative field for clipping the aneurysm without difficulty. In the remaining patient, in whom the aneurysm was located at the midline on the clivus at the level of the hypoglossal canal, the aneurysm could not be found by using the transcondylar fossa approach; thus, the route was changed to the transcondylar approach, and clipping was performed below the hypoglossal nerve rootlets. CONCLUSIONS Both approaches offer excellent visualization and a wide working field, with ready access to the lesion. This remarkably reduces the risk of development of postoperative deficits. These approaches should be used properly; the transcondylar fossa approach is indicated for aneurysms located above the hypoglossal canal and the transcondylar approach is indicated for those located below it.
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Affiliation(s)
- T Matsushima
- Department of Neurosurgery, Neurological Institute, Kyushu University, Fukuoka, Japan
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