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Allam AK, Larkin MB, Sharma H, Viswanathan A. Trigeminal and Glossopharyngeal Neuralgia. Neurol Clin 2024; 42:585-598. [PMID: 38575268 DOI: 10.1016/j.ncl.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Trigeminal neuralgia and glossopharyngeal neuralgia are craniofacial pain syndromes characterized by recurrent brief shock-like pains in the distributions of their respective cranial nerves. In this article, the authors aim to summarize each condition's characteristics, pathophysiology, and current pharmacotherapeutic and surgical interventions available for managing and treating these conditions.
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Affiliation(s)
- Anthony K Allam
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - M Benjamin Larkin
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Himanshu Sharma
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
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Vilanilam GK, Gopal N, Middlebrooks EH, Huang JF, Bhatt AA. Compressive lesions of the head and neck: Common and uncommon must-know entities. Neuroradiol J 2024; 37:164-177. [PMID: 37026517 PMCID: PMC10973822 DOI: 10.1177/19714009231166083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
There are many lesions that cause compression of nerves and vessels in the head and neck, and they can often be overlooked in the absence of adequate history or if not suspected by the radiologist. Many of these lesions require a high index of suspicion and optimal positioning for imaging. While a multimodality approach is critical in the evaluation of compressive lesions, an MRI utilizing high-resolution (heavily weighted) T2-weighted sequence is extremely useful as a starting point. In this review, we aim to discuss the radiological features of the common and uncommon compressive lesions of the head and neck which are broadly categorized into vascular, osseous, and miscellaneous etiologies.
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Affiliation(s)
- George K Vilanilam
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Neethu Gopal
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Erik H Middlebrooks
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Alok A Bhatt
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
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You S, Qin X, Tong L, Feng Z. Long-Term Follow-Up of Ultrasound-Guided Glossopharyngeal Nerve Block Treatment for Glossopharyngeal Neuralgia: A Retrospective Clinical Study of 43 Cases. J Pain Res 2024; 17:913-921. [PMID: 38476875 PMCID: PMC10927459 DOI: 10.2147/jpr.s437609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Background Glossopharyngeal neuralgia (GPN) is a rare chronic neuropathic pain disorder that significantly impacts quality of life. Ultrasound-guided glossopharyngeal nerve blocks (UGPNB) have gained popularity due to their various advantages. However, there have been no studies reporting the long-term outcomes of UGPNB in a larger cohort of GPN patients. Aim This study aims to evaluate the efficacy and safety of UGPNB in patients with GPN. Methods We reviewed the electronic medical records of patients with GPN who received UGPNB at the Department of Pain Medicine of the First Medical Center, PLA General Hospital between June 1, 2011, and June 1, 2022. The effect of UGPNB was evaluated using the Barrow Neurological Institute (BNI) scale. Improvement was defined as a reduction in pain category by comparing pain categories before and after therapy. Recovery was defined as achieving BNI I after treatment. Patients who responded to treatment but then regressed to the category before therapy were considered to have experienced pain relapse. Results A total of 43 patients with GPN who received UGPNB were included in the analysis. At discharge, 35 (81.4%) patients experienced pain improvement after treatment, and among them, 13 (30.2%) patients achieved recovery. After discharge, 13 patients (37.1%) out of the 35 effective patients experienced pain relapse at different time intervals: 0.5, 0.7, 1, 1, 3, 3, 4, 12, 15, 36, 45, 63, and 96 months. The cumulative recurrence-free survival rates were 88.85% at month 1, 82.83% at month 3, 77.04% at month 12, 70.31% at month 36, and 54.66% at month 120. Among the 13 patients who experienced relapse, four patients received a second UGPNB treatment, and pain improved in two patients (50%). No severe adverse reactions were documented. Conclusion UGPNB is an effective, repeatable, safe, and minimally invasive treatment for patients with GPN. It may be preferable to consider UGPNB before undergoing invasive intracranial surgery or neurodestructive methods.
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Affiliation(s)
- Shaohua You
- Department of Pain Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Xiaoyan Qin
- Department of Clinical Laboratory, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, 100049, People’s Republic of China
| | - Li Tong
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Zeguo Feng
- Department of Pain Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
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Fan H, Wang L, Xia S, Xu X, Su S, Feng W, Wu C, Lou C, Chen Y. Glossopharyngeal Neuralgia Characterized by Otalgia: A Retrospective Study. J Craniofac Surg 2023; 34:e739-e743. [PMID: 37418618 DOI: 10.1097/scs.0000000000009521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/17/2023] [Indexed: 07/09/2023] Open
Abstract
Glossopharyngeal neuralgia (GPN) is an uncommon facial pain syndrome and is characterized by paroxysms of excruciating pain in the distributions of the auricular and pharyngeal branches of cranial nerves IX and X. Glossopharyngeal neuralgia characterized by otalgia alone is rare. Herein, the authors analyzed 2 patients with GPN with otalgia as the main clinical manifestation. The clinical features and prognosis of this rare group of patients with GPN were discussed. They both presented with paroxysmal pain in the external auditory meatus and preoperative magnetic resonance imaging suggested the vertebral artery were closely related to the glossopharyngeal nerves. In both patients, compression of the glossopharyngeal nerve was confirmed during microvascular decompression, and the symptoms were relieved immediately after surgery. At 11 to 15 months follow-up, there was no recurrence of pain. A variety of reasons can cause otalgia. The possibility of GPN is a clinical concern in patients with otalgia as the main complaint. The authors think the involvement of the glossopharyngeal nerve fibers in the tympanic plexus via Jacobson nerve may provide an important anatomic basis for GPN with predominant otalgia. Surface anesthesia test of the pharynx and preoperative magnetic resonance imaging is helpful for diagnosis. Microvascular decompression is effective in the treatment of GPN with predominant otalgia.
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Affiliation(s)
- Haonan Fan
- Department of Neurosurgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu
| | - Linkai Wang
- Department of Neurosurgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu
| | - Siqi Xia
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Xiaohui Xu
- Department of Neurosurgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu
| | - Sheng Su
- Department of Neurosurgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu
| | - Weijian Feng
- Department of Neurosurgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu
| | - Chunlai Wu
- Department of Neurosurgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu
| | - Chengjian Lou
- Department of Neurosurgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu
| | - Yili Chen
- Department of Neurosurgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu
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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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Doneddu PE, Pensato U, Iorfida A, Alberti C, Nobile-Orazio E, Fabbri A, Voza A. Neuropathic Pain in the Emergency Setting: Diagnosis and Management. J Clin Med 2023; 12:6028. [PMID: 37762968 PMCID: PMC10531819 DOI: 10.3390/jcm12186028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Neuropathic pain, traditionally considered a chronic condition, is increasingly encountered in the emergency department (ED), accounting for approximately 20% of patients presenting with pain. Understanding the physiology and key clinical presentations of neuropathic pain is crucial for ED physicians to provide optimal treatment. While diagnosing neuropathic pain can be challenging, emphasis should be placed on obtaining a comprehensive medical history and conducting a thorough clinical examination. Patients often describe neuropathic pain as a burning or shock-like sensation, leading them to seek care in the ED after ineffective relief from common analgesics such as paracetamol and NSAIDs. Collaboration between emergency medicine specialists, neurologists, and pain management experts can contribute to the development of evidence-based guidelines specifically tailored for the emergency department setting. This article provides a concise overview of the common clinical manifestations of neuropathic pain that may prompt patients to seek emergency care.
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Affiliation(s)
- Pietro Emiliano Doneddu
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
| | - Umberto Pensato
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Neurology and Stroke Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Alessandra Iorfida
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Emergency Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Claudia Alberti
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Department of Medical Biotechnology and Translational Medicine, Milan University, 20133 Milano, MI, Italy
| | - Andrea Fabbri
- Emergency Department AUSL Romagna, Presidio Ospedaliero Morgagni-Pierantoni, 47121 Forlì, FC, Italy
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Emergency Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
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Marques A, Caldeira D, Alegria S, Pereira AR, João I, Pereira H. Glossopharyngeal neuralgia with cardioinhibitory syncope: Is a permanent pacemaker required? Rev Port Cardiol 2023; 42:805-809. [PMID: 37019279 DOI: 10.1016/j.repc.2019.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/21/2019] [Accepted: 12/01/2019] [Indexed: 04/05/2023] Open
Abstract
Glossopharyngeal neuralgia is a rare facial pain syndrome, which in more rare cases can be associated with syncope. We present the outcome of a case report that combines this rare association that received medical therapy with anti-epileptic medication and permanent dual chamber pacemaker implantation. In this case, syncope episodes were associated with both vasodepressor and cardioinhibitory reflex syncope types. The patient found relief from syncope, hypotension, and pain after initiation of anti-epileptic therapy. Although a dual chamber pacemaker was implanted, the pacemaker interrogation revealed no requirement for pacing at one-year follow-up. As far as we know, this is the first case that reports pacemaker interrogation during follow-up and, taking into account the absence of pacemaker activation at one-year follow-up, the device was not needed to prevent bradycardia and syncope episodes. This case report supports the current guidelines for pacing in neurocardiogenic syncope, by demonstrating a lack of requirement for pacing in the event of both cardioinhibitory and vasodepressor responses.
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Affiliation(s)
- Ana Marques
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal.
| | - Daniel Caldeira
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Centro Cardiovascular da Universidade de Lisboa - CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sofia Alegria
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Rita Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Isabel João
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Hélder Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
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Wang L, Liu Q, Dong X, Wang J. Comparative analysis of MVD and RHZ in the treatment of primary glossopharyngeal neuralgia: A clinical report on 61 cases. Front Neurol 2023; 14:1024142. [PMID: 36860578 PMCID: PMC9968861 DOI: 10.3389/fneur.2023.1024142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/18/2023] [Indexed: 02/17/2023] Open
Abstract
Objective Clinical data on 61 patients (grouped by their treatment with MVD or RHZ) with glossopharyngeal neuralgia were analyzed retrospectively. A summary analysis of the effective rate and surgical complications of MVD and RHZ in the treatment of glossopharyngeal neuralgia was performed to observe the new surgical options for GN. Method From March 2013 to March 2020, 63 patients with GN were admitted to our hospital by the professional group of cranial nerve diseases. Two patients diagnosed with tongue and pharynx pain secondary to tongue cancer and upper esophageal cancer, respectively were excluded from the group. The remaining patients all met the diagnosis of GN, some of them were treated with MVD and others were treated with RHZ. The pain relief rate, long-term results, and complications of the patients in the two groups were well-organized and analyzed. Result Of the 61 patients, 39 were treated with MVD and 22 were treated with RHZ. In the early-stage patients (the first 23 patients), all of them were operated on with the MVD procedure except one patient without vascular compression. In the later-stage patients, MVD was performed for evident single arterial compression according to the intraoperative situation. And for compression of arteries with greater tension or PICA + VA complex compression, RHZ was performed. It was also performed in cases where vessels with tight adhesions to the arachnoid and nerves could not be easily separated, or where it was easy to damage the perforating arteries after separating the blood vessels, causing vasospasm, which affects the blood supply to the brainstem and cerebellum. RHZ was also performed if there was no clear vascular compression. The efficiency of both groups was 100%. In the MVD group, one case recurred 4 years after the initial operation, and RHZ was performed for reoperation. Complications related to the operation included one case of swallowing and coughing in the MVD group, and three cases in the RHZ group; two cases of uvula not centering in the MVD group, and five cases in the RHZ group. There was 2 patients in RHZ group lost taste in 2/3 of the backing of the tongue, though these symptoms mostly disappeared or decreased after follow-up. One patient in the RHZ group had developed tachycardia by the time of the long-term follow-up, but whether it was related to the surgery is still uncertain. In terms of serious complications, there were two cases of postoperative bleeding in the MVD group. Based on the clinical characteristics of the patients' bleeding, it was judged that the cause of the bleeding was ischemia and was related to an intraoperative injury to the penetrating artery of the PICA artery and vasospasm. Conclusion MVD and RHZ are effective methods for the treatment of primary glossopharyngeal neuralgia. MVD is recommended for cases where vascular compression is clear and easy to handle. However, for cases with complex vascular compression, tight vascular adhesions, difficult separation, and without clear vascular compression, RHZ could be performed. Its efficiency is equivalent to MVD, and there is no significant increase in complications such as cranial nerve disorders. There are few cranial nerve complications that seriously affect the quality of life of patients. RHZ helps to reduce the risk of ischemia and bleeding during surgery by reducing the risk of arterial spasms and injury to the penetrating arteries by separating the vessels due to separation of vessels during MVD. At the same time, it may reduce the postoperative recurrence rate.
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Affiliation(s)
- Leibo Wang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | | | - Xiaoxia Dong
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Junwei Wang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
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Wu L, Xiong J, Huang Y, Han K, Cai K, Fu X. Case report: Trigeminal neuralgia misdiagnosed as glossopharyngeal neuralgia. Front Neurol 2023; 14:1079914. [PMID: 36741284 PMCID: PMC9892896 DOI: 10.3389/fneur.2023.1079914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023] Open
Abstract
Background Trigeminal neuralgia (TN) and glossopharyngeal neuralgia (GPN) are cranial nerve neuralgias with the same clinical manifestations, pathological features, and trigger factors; their affected sites are adjacent. Performing a magnetic resonance imaging (MRI) examination alone can easily lead to a misdiagnosis. Case presentation A 72-year-old man had visited another hospital with severe left-sided tongue pain. On MRI, vascular compression of the glossopharyngeal nerve had been visible, with unclear evidence of trigeminal nerve involvement. He had been diagnosed with left-sided GPN and underwent microvascular decompression (MVD) of the left glossopharyngeal nerve. However, no improvement was observed after surgery. During a second surgery at our hospital, MVD of the trigeminal nerve was performed, and the trigeminal nerve was fully explored and separated. The patient's pain resolved after surgery. Ultimately, the patient was definitively diagnosed with left-sided TN. Discussion and conclusion MVD is currently the most efficacious surgical option for treating cranial nerve neuralgia. To select patients for MVD, having an MRI criteria for identifying true neurovascular compression will be helpful. However, clinicians should focus more on a patient's clinical symptoms and not rely solely on MRI findings. This patient's case can help clinicians distinguish between TN and GPN, improve the understanding of these diseases, avoid misdiagnosis, and reduce the possibility of secondary damage.
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Affiliation(s)
- Liangzhe Wu
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
| | - Jinbiao Xiong
- Department of Neurosurgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Ying Huang
- Department of Neurology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Kunning Han
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
| | - Kunhao Cai
- Department of Neurosurgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China,*Correspondence: Kunhao Cai ✉
| | - Xuejun Fu
- Department of Neurology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China,Xuejun Fu ✉
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Park JS, Ahn YH. Glossopharyngeal Neuralgia. J Korean Neurosurg Soc 2023; 66:12-23. [PMID: 36480819 PMCID: PMC9837485 DOI: 10.3340/jkns.2022.0178] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
Glossopharyngeal neuralgia (GPN) is a rare disease that must be differentiated from trigeminal neuralgia. The purpose of this article is to provide a comprehensive review of anatomy, pathophysiology, diagnostic criteria, and several options of treatment for GPN. Lessons learned through our experience of treating GPN are presented in detail, as well as cases of misdiagnosis and diagnostic pitfalls. Microvascular decompression (MVD) should be primarily considered for medically intractable GPN. Techniques employed in MVD for GPN are categorized and described. Especially, we underscore the advantages of the 'transposition' technique where insulating material is positioned 'off' the root entry zone (REZ), instead of 'on' it. We believe this 'off-the-REZ' technique can fundamentally prevent recurrence, if applicable. In addition, Gamma Knife radiosurgery can be an alternative option when a patient is ineligible for MVD, though it is categorized as a destructive procedure.
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Affiliation(s)
- Jae Sung Park
- Department of Neurosurgery, Konyang University College of Medicine, Daejeon, Korea
| | - Young Hwan Ahn
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea
- Neuroscience Graduate Program, Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, Korea
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Zheng W, Zhao P, Song H, Liu B, Zhou J, Fan C, Wang D, Liu R. Prognostic factors for long-term outcomes of microvascular decompression in the treatment of glossopharyngeal neuralgia: a retrospective analysis of 97 patients. J Neurosurg 2022; 137:820-827. [PMID: 34920419 DOI: 10.3171/2021.9.jns21877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors aimed to investigate predictors of postoperative outcomes of microvascular decompression (MVD) for the treatment of glossopharyngeal neuralgia (GPN). METHODS A cohort of 97 patients with medically refractory GPN who underwent MVD at the authors' institution between January 2010 and July 2019 was retrospectively reviewed. Univariate and multivariate regression models were used to identify predictors of long-term outcome in patients after MVD. RESULTS Eighty-nine patients (91.8%) reported immediate and complete relief of pain after the procedure. Of the remaining 8 patients (8.2%), 6 achieved partial pain relief and pain gradually diminished within 2 weeks after surgery, and 2 did not experience postoperative pain relief. In univariate Cox regression analysis, venous compression of the glossopharyngeal nerve root entry zone (HR 3.591, 95% CI 1.660-7.767, p = 0.001) and lower degree of neurovascular conflict (HR 2.449, 95% CI 1.177-5.096, p = 0.017) were significantly associated with worse pain-free survival. In multivariate Cox regression analysis, venous compression (HR 8.192, 95% CI 2.960-22.669, p < 0.001) and lower degree of neurovascular conflict (HR 5.450, 95% CI 2.069-14.356, p = 0.001) remained independently associated with worse pain-free survival. CONCLUSIONS Venous compression of the glossopharyngeal nerve root entry zone and lower degree of neurovascular conflict were significantly correlated with shorter pain-free survival in patients who underwent MVD for GPN. Microvascular decompression is a safe, feasible, and durable approach with a low complication rate for the treatment of GPN.
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Abstract
Cranial neuralgia (CN) can cause significant debilitating pain within a nerve dermatome. Accurate diagnosis requires detailed clinical history and examination, understanding of pathophysiology and appropriate neuroimaging to develop an optimal treatment plan. The objective of this article is to review and discuss some of the more common CNs including trigeminal neuralgia and its associated painful neuropathies, occipital neuralgia, and less common glossopharyngeal neuralgia (GPN). The neuroanatomy, pathophysiology, diagnostic imaging, and treatment of each of these pathologies are reviewed with emphasis on the role of CT and MR imaging findings in guiding diagnosis. Although CT is often used to initially identify an underlying cause such as neoplasm, infection, or vascular malformation, MRI is optimal. Clinical history and examination findings along with MRI constructive interference steady state/fast imaging employing steady-state acquisition sequences and MRA of the brain can be used to distinguish between primary and secondary cranial neuropathies and to discern the best treatment option. Pharmacologic and noninvasive therapy is the first-line of treatment of these cranial and cervical neuralgias. If symptoms persist, stereotactic radiosurgery is an option for some patients, although microvascular decompression surgery is the most curative option for both trigeminal and GPN. Refractory occipital neuralgia can be treated with a nerve block, an ablative procedure such as neurectomy or ganglionectomy, or more recently occipital nerve stimulation.
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Affiliation(s)
- Samika Kanekar
- Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Manal Saif
- Department of Radiology, Penn State Health, Penn State College of Medicine, Mail Code H066 500 University Drive, Hershey, PA 17033, USA
| | - Sangam Kanekar
- Radiology Research, Division of Neuroradiology, Penn State Health, Penn State College of Medicine, Mail Code H066 500 University Drive, Hershey, PA 17033, USA.
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Han A, Montgomery C, Zamora A, Winder E, Kaye A, Carroll C, Aquino A, Kakazu J, Kaye A. Glossopharyngeal Neuralgia: Epidemiology, Risk factors, Pathophysiology, Differential diagnosis, and Treatment Options. Health Psychol Res 2022; 10:36042. [PMID: 35774913 DOI: 10.52965/001c.36042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/04/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose of Review This is a comprehensive review of the most recent literature on glossopharyngeal neuralgia (GPN), a relatively rare form of neuropathic facial pain. It covers the epidemiology, risk factors, pathophysiology, and differential diagnosis given that glossopharyngeal neuralgia can often be confused with other facial pain syndromes. Finally, we extensively review recent findings regarding medical or conservative measures, minimally invasive, and surgical options for potentially treating and managing glossopharyngeal neuralgia. Recent Findings An in-depth analysis of the recent literature indicates that glossopharyngeal neuralgia is not only rare but its etiology and pathophysiology are complex and are often secondary to other disease processes. Regardless, current management options are shown to be effective in controlling pain. Conservatively, first-line management of GPN is carbamazepine, but gabapentin and eslicarbazepine acetate are suitable alternatives. In terms of current minimally invasive pain management techniques, pulsed radiofrequency ablation, nerve blocks, or percutaneous radiofrequency thermocoagulation are effective. Finally, surgical management involves microvascular decompression and rhizotomy. Summary While there are currently many viable options for addressing glossopharyngeal neuralgia pain ranging from conservative to surgical management, the complex nature of GPN etiology, pathophysiology, and involved anatomical structures prompts further research for more effective ways to treat the disease.
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Affiliation(s)
- Andrew Han
- School of Medicine, Georgetown University School of Medicine
| | | | | | | | - Adam Kaye
- Pharmacy and Health Sciences, Thomas J. Long School of Pharmacy and Health Sciences
| | | | | | - Juyeon Kakazu
- School of Medicine, Georgetown University School of Medicine
| | - Alan Kaye
- Louisiana State University Shreveport
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Shi X, Zhang X, Xu L, Xu Z. Neurovascular Compression Syndrome:Trigeminal neuralgia, Hemifacial spasm, Vestibular paroxysmia, Glossopharyngeal neuralgia, four case reports and review of literature. Clin Neurol Neurosurg 2022; 221:107401. [DOI: 10.1016/j.clineuro.2022.107401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/02/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022]
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15
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Tizzoni R, Tizzoni M, Clerici CA. Atypical odontalgia and trigeminal neuralgia: psychological, behavioral and psychopharmacological approach in a dental clinic – an overview of pathologies related to the challenging differential diagnosis in orofacial pain. F1000Res 2022; 10:317. [PMID: 35966965 PMCID: PMC9345266 DOI: 10.12688/f1000research.51845.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 12/03/2022] Open
Abstract
Orofacial pain represents a challenge for dentists, especially if it does not have an odontogenic origin. Orofacial neuropathic pain may be chronic, is arduous to localize and may develop without obvious pathology. Comorbid psychiatric disorders, such as anxiety and depression, coexist and negatively affect this condition. This article presents one case of atypical odontalgia and one of trigeminal neuralgia treated with psychological and psychopharmacological tailored and adapted therapies, after conventional medications had failed. Additionally, an overview of the pathologies related to the challenging differential diagnosis in orofacial pain is given. A 68-year-old man complained of chronic throbbing and burning pain in a maxillary tooth, which worsened upon digital pressure. Symptoms did not abate after amitriptyline therapy; psychological intervention along with antianxiety drug were supplemented and antidepressant agent dosage were incremented. The patient reported improvement and satisfaction with the multidisciplinary approach to his pathology. A 72-year-old man complained of chronic stabbing, intermittent, sharp, shooting and electric shock-like pain in an upper tooth, radiating and following the distribution of the trigeminal nerve. Pain did not recur after psychological intervention and a prescription of antidepressant and antianxiety agents, while carbamazepine therapy had not been sufficient to control pain. Due to concerns with comorbid psychiatric disorders, we adopted a patient-centered, tailored and balanced therapy, favorably changing clinical outcomes. Comorbid psychiatric disorders have a negative impact on orofacial pain, and dentists should consider adopting tailored therapies, such as psychological counselling and behavioral and psychopharmacologic strategies, besides conventional treatments. They also must be familiar with the signs and symptoms of orofacial pain, obtaining a comprehensive view of the pathologies concerning the differential diagnosis. A prompt diagnosis may prevent pain chronicity, avoiding an increase in complexity and a shift to orofacial neuropathic pain and legal claims.
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Affiliation(s)
| | | | - Carlo Alfredo Clerici
- Department of Oncology and Haematology-Oncology,, University of Milano, 20122 Milano, Italy
- Clinical Psychology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, 20133 Milano, Italy
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16
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Neuralgia and Atypical Facial, Ear, and Head Pain. Otolaryngol Clin North Am 2022; 55:595-606. [DOI: 10.1016/j.otc.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Wolcott Z, Goldstein ED. A man with tongue pain: A case study. Headache 2021; 61:1295-1298. [PMID: 34510447 DOI: 10.1111/head.14183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Zoe Wolcott
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Eric D Goldstein
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
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18
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Robertson C. Cranial Neuralgias. Continuum (Minneap Minn) 2021; 27:665-685. [PMID: 34048398 DOI: 10.1212/con.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article discusses the differential diagnosis, evaluation, and management of trigeminal neuralgia and reviews other neuralgias of the head and neck, including those that contribute to neuralgic ear pain. RECENT FINDINGS Most cases of trigeminal neuralgia are related to vascular compression, a demyelinating plaque, or a compressive mass affecting the trigeminal nerve. However, recent studies have shown that up to 11% of patients have a family history of trigeminal neuralgia, suggesting that some patients may have a genetic predisposition to demyelination or nerve hyperexcitability. In these patients, trigeminal neuralgia may occur at a younger age, on both sides of the face, or in combination with other neuralgias. SUMMARY When a patient presents with neuralgic pain, the diagnosis is made by careful history and neurologic examination, with attention to the dermatome involved, the triggers, and the presence of any associated sensory deficit. All patients with new neuralgia or neuropathic facial pain warrant a careful evaluation for a secondary cause. The presence of sensory deficit on bedside examination is particularly concerning for an underlying secondary etiology.
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Wang X, Meng D, Wang L, Chen G. The Clinical Characteristics and Surgical Treatment of Glossopharyngeal Neuralgia With Pain Radiating to the Innervated Area of the Trigeminal Nerve. J Oral Maxillofac Surg 2020; 79:786.e1-786.e8. [PMID: 33387474 DOI: 10.1016/j.joms.2020.11.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/28/2020] [Accepted: 11/29/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the clinical characteristics and surgical outcome of microvascular decompression (MVD) with or without glossopharyngeal nerve and partial vagus nerve rhizotomy for treating glossopharyngeal neuralgia (GPN) patients with pain radiating to the area innervated by the trigeminal nerve. METHODS A retrospective review was performed to collect the clinical data from GPN patients who had pain in the area innervated by the glossopharyngeal and vagus nerves and radiating to the innervated area of the trigeminal nerve. All patients underwent surgical treatment. The immediate and long-term outcomes were investigated to show the efficacy and safety of the treatment. Information on pain recurrence and complications was collected. RESULTS Fourteen patients were recruited. The pain area radiated to the trigeminal nerve distribution, including the anterior auricle (57.1%), temple (50%), cheek (28.6%), mandibular gingiva (42.9%), and anterior part of the tongue (14.3%). Swallowing was the most common trigger (85.7%) in these patients. Seven patients underwent MVD of the offending vessel at the root entry zone (REZ) of the glossopharyngeal and vagus nerves. Seven patients underwent MVD plus glossopharyngeal nerve rhizotomy with or without partial vagus nerve rhizotomy. Thirteen patients experienced complete pain relief during the follow-up (mean 49.3 months). CONCLUSIONS GPN patients with pain radiating to the area innervated by the trigeminal nerve could be successfully treated solely by management of the glossopharyngeal and vagus nerves. In these GPN patients, differential diagnosis is extremely important to identify the true diagnosis, which would reduce the occurrence of iatrogenic injury of the trigeminal nerve during treatment.
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Affiliation(s)
- Xiaosong Wang
- Fellow, Department of Neurosurgery, Aviation General Hospital, Beijing, China
| | - Dawei Meng
- Resident, Department of Neurosurgery, Aviation General Hospital, Beijing, China
| | - Lin Wang
- Fellow, Department of Neurosurgery, Aviation General Hospital, Beijing, China
| | - Guoqiang Chen
- Professor, Department of Neurosurgery, Aviation General Hospital, Beijing, China.
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Abstract
While non-headache, non-oral craniofacial neuralgia is relatively rare in incidence and prevalence, it can result in debilitating pain. Understanding the relevant anatomy of peripheral branches of nerves, natural history, clinical presentation, and management strategies will help the clinician better diagnose and treat craniofacial neuralgias. This article will review the nerves responsible for neuropathic pain in periorbital, periauricular, and occipital regions, distinct from idiopathic trigeminal neuralgia. The infratrochlear, supratrochlear, supraorbital, lacrimal, and infraorbital nerves mediate periorbital neuralgia. Periauricular neuralgia may involve the auriculotemporal nerve, the great auricular nerve, and the nervus intermedius. The greater occipital nerve, lesser occipital nerve, and third occipital nerve transmit occipital neuralgias. A wide range of treatment options exist, from modalities to surgery, and the evidence behind each is reviewed.
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Affiliation(s)
- Sheryl D Katta-Charles
- Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, 4141 Shore Drive, Indianapolis, IN, USA
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Jia Y, Shrestha N, Wang X, Wang T, Luo F. The Long-Term Outcome of CT-Guided Pulsed Radiofrequency in the Treatment of Idiopathic Glossopharyngeal Neuralgia: A Retrospective Multi-Center Case Series. J Pain Res 2020; 13:2093-2102. [PMID: 32904498 PMCID: PMC7455598 DOI: 10.2147/jpr.s259994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/18/2020] [Indexed: 12/18/2022] Open
Abstract
Background Safer and minimal invasive treatment options with minor side effects are in great demand in the treatment of glossopharyngeal neuralgia (GPN). Pulsed radiofrequency (PRF) is a micro-destructive procedure that could be applied repeatedly without irreversible damage to target tissue. However, few studies have reported the long-term clinical outcomes of PRF in the management of idiopathic GPN patients. Methods We retrospectively investigated the efficacy and safety of computed tomography (CT)-guided PRF in the treatment of 30 patients with idiopathic GPN in a multi-center clinical study. Numeric rating scale (NRS) score was used to evaluate pain intensity before and after PRF treatment. The effective rate was defined as the percentage of patients with NRS reduction of more than 50%. Baseline characteristics, surgical records, initial pain relief, time to take effect, long-term outcomes, patient satisfaction using a five-level Likert Scale, the incidence of recurrence as well as subsequent treatment choices, intraoperative and postoperative complications were retrieved from electronic medical records. Results A total of 30 idiopathic GPN patients who received PRF under CT-guidance were included in our study and the initial effective rate was 93.3%. The cumulative proportion of patients with satisfactory pain relief survival was 93.3% at 12 months, 89.6% at 24 months, 85.3% at 36 months, 79.6% at 48 months, 73.0% at 60 months and 72 months, and 54.8% at 84 months, 108 months as well as 120 months. No serious morbidity or mortality were observed in any of the cases. The median patient satisfaction in Likert scale rating was 4.0 (IQR, 3.0–5.0). Conclusion According to our results, PRF is an effective and safe therapy for patients with idiopathic GPN. This minimally invasive, micro-destructive, neuro-modulatory technique could be a potential intervention of choice for the treatment of GPN patients who respond poorly to pharmacological treatment.
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Affiliation(s)
- Yitong Jia
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Niti Shrestha
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaodi Wang
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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Hong SA, LaGorio L, Husain I. Post-tonsillectomy dysphagia secondary to glossopharyngeal nerve injury. BMJ Case Rep 2020; 13:13/1/e232657. [PMID: 31907218 DOI: 10.1136/bcr-2019-232657] [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] [Indexed: 11/03/2022] Open
Abstract
The glossopharyngeal nerve lies in close proximity to the tonsillar fossa making it susceptible to injury during tonsillectomy, though it is uncommonly injured in practice. We present a case of severe dysphagia due to glossopharyngeal nerve injury following tonsillectomy and demonstrate the efficacy of the McNeill Dysphagia Therapy Program (MDTP), a novel stepwise exercise-based rehabilitation program, in improving clinical outcomes. In patients with persistent, severe dysphagia following tonsillectomy, glossopharyngeal nerve injury should be on the differential diagnosis. The MDTP is one method by which clinicians may be able to treat this complex condition.
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Affiliation(s)
- Scott A Hong
- Department of Otolaryngology - Head & Neck Surgery, Saint Louis University, Saint Louis, Missouri, USA
| | - Lisa LaGorio
- Department of Communication Disorders and Sciences, Rush University, Chicago, Illinois, USA
| | - Inna Husain
- Department of Otolaryngology, Rush University, Chicago, Illinois, USA
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23
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Aggarwal A, Suresh V. Radiofrequency ablation and phenol neurolysis in a case of glossopharyngeal neuralgia due to a rare aetiology. Indian J Anaesth 2020; 64:437-439. [PMID: 32724257 PMCID: PMC7286389 DOI: 10.4103/ija.ija_9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/20/2020] [Accepted: 02/29/2020] [Indexed: 11/06/2022] Open
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Sude A, Nixdorf DR, Grande AW. Human papillomavirus-positive oropharyngeal squamous cell carcinoma manifesting as glossopharyngeal neuralgia. J Am Dent Assoc 2019; 150:1059-1061. [PMID: 31761020 DOI: 10.1016/j.adaj.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
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25
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Baldauf J, Rosenstengel C, Schroeder HWS. Nerve Compression Syndromes in the Posterior Cranial Fossa. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:54-60. [PMID: 30855007 DOI: 10.3238/arztebl.2019.0054] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 03/29/2018] [Accepted: 10/04/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nerve compression syndromes in the posterior cranial fossa can severely impair patients' quality of life. There is often uncertainty about the best treatment. In this article, we provide an overview of these conditions and the corresponding treatment strategies. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed and on a scientific analysis of the authors' patient collective. RESULTS These syndromes are caused by compression of a cranial nerve by an artery or vein at the zone of the nerve's entry to or exit from the brainstem. The best-known neurovascular compression syndrome is trigeminal neuralgia, followed by hemifacial spasm. Less well known are glossopharyngeal neuralgia, nervus intermedius neuralgia, and vestibular paroxysmia. The initial treatment of trigeminal neuralgia is medical: the first line of treatment is with sodium-blocking anticon- vulsants, such as carbamazepine. For patients with hemifacial spasm, botulinum toxin injection is the recommended initial treatment and often leads to a satisfactory regression of the spasms. If these treatments fail, a microvascular decompression operation is indicated. The aim of the procedure is to separate the irritating vessel from the nerve and to keep these structures apart permanently. There is hardly any available evidence on these treatment strategies from randomized controlled trials. CONCLUSION Nerve compression syndromes in the posterior cranial fossa can generally be treated nonsurgically at first. Over the course of the condition, however, treatment failure or intolerable side effects may arise. In such cases, a microvascu- lar decompression operation is indicated. This is a causally directed form of treat- ment that generally yields very good results.
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Affiliation(s)
- Jörg Baldauf
- Department of Neurosurgery, University Medicine Greifswald
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26
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Abstract
PURPOSE OF REVIEW This article describes the clinical features and diagnostic criteria, pathophysiology (when known), and treatment strategies of the major cranial neuralgias. RECENT FINDINGS Abnormal vascular loops compressing cranial nerves are the most common known pathogenesis associated with the primary neuralgias. SUMMARY The most frequently encountered primary neuralgias are trigeminal neuralgia, occipital neuralgia, and, rarely, glossopharyngeal neuralgia. Nervus intermedius neuralgia is even more rare. All neuralgias merit a careful workup for secondary causes. Drug treatment generally relies on antiepileptic drugs, antidepressants, and baclofen. OnabotulinumtoxinA can be useful in treating some cranial neuralgias. Surgical and invasive treatments include ablation, gamma knife treatment, and microvascular decompression.
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Liu J, Shen Y, Jiang B, Yuan Y, Yu Y. Ameliorating Effect of Microvascular Decompression on Patients with Coexistence of Hemifacial Spasm and Glossopharyngeal Neuralgia: A Retrospective Study. World Neurosurg 2019; 133:e62-e67. [PMID: 31442648 DOI: 10.1016/j.wneu.2019.08.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Microvascular decompression (MVD) has been widely accepted for treating hemifacial spasm (HFS) and glossopharyngeal neuralgia (GN); an effective surgical treatment of coexistent HFS and GN still remains to be determined, however. In this paper we discuss the operative strategy of MVD for patients with coexistent HFS and GN. METHODS This was a retrospective study. All cases of HFS with or without GN at China-Japan Friendship Hospital from January 2014 to June 2016 have been included. All patients underwent MVD and have been followed up for an average of 1.5 years. RESULTS A total of 5375 cases of HFS were included, wherein 8 cases coexist with GN. Eight patients had same offending vessel(s) compressing the root entry zone of glossopharyngeal nerve and facial nerve. Posterior inferior cerebellar artery was identified as at least 1 of the offending arteries in all 8 patients. After MVD, spasm ceased in all 8 cases, with 7 cases ceasing immediately and 1 within 2 months. Pain disappeared also in all cases, with 7 cases immediately and 1 case after 4 days. No recurrence or complication was observed during the follow-ups. CONCLUSIONS HFS combined with ipsilateral GN was rare. MVD could be performed to effectively relieve nerve root compression and associated symptoms for coexistent HFS and GN. Sufficient exposure of root entry zones of both nerves and fully decompression of offending blood vessels and exploratory sequences of different nerve roots are critical points for improving operative effect and reducing complications.
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Affiliation(s)
- Jiang Liu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Yuxiao Shen
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Bowen Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yue Yuan
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Yanbing Yu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China.
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28
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Liu Q, Zhong Q, Tang G, He G. Ultrasound-guided glossopharyngeal nerve block via the styloid process for glossopharyngeal neuralgia: a retrospective study. J Pain Res 2019; 12:2503-2510. [PMID: 31496791 PMCID: PMC6690851 DOI: 10.2147/jpr.s214596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/23/2019] [Indexed: 11/23/2022] Open
Abstract
Objective To examine the effectiveness and safety of ultrasound-guided glossopharyngeal nerve block via the styloid process for primary glossopharyngeal neuralgia. Methods This retrospective study included all patients receiving glossopharyngeal nerve block via the styloid process under ultrasound guidance for primary glossopharyngeal neuralgia between January 2015 and May 2018 at our hospital. The primary outcome of the study was pain relief as assessed using the visual analog scale (VAS). Treatment was considered effective if the VAS score decreased by more than 2 points. Results Twelve patients were included in the analysis. The baseline VAS scores ranged from 5 to 9. All patients received previous pharmacotherapy. Other previous treatments included pulsed mode radiofrequency (n=4), microvascular decompression (n=2), and glossopharyngeal nerve block (not under ultrasound guidance; n=2). The patients completed a total of 48 injections for glossopharyngeal nerve block. At discharge from the hospital, and at 6, 12, and 18 months thereafter, 10/12, 10/12, 7/12, and 4/12 patients achieved pain relief and the effective rate was 83.3% at discharge, 83.3% at 6 months, 58.3% at 1 year, and 33.3% at 18 months, respectively. Conclusion Ultrasound-guided glossopharyngeal nerve block via the styloid process is a safe, radiation-free, repeatable, convenient, and effective treatment. It can provide a treatment option for patients with glossopharyngeal neuralgia.
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Affiliation(s)
- Qian Liu
- Department of Anesthesiology, First People's Hospital, Zigong, Sichuan, People's Republic of China
| | - Qing Zhong
- Department of Anesthesiology, People's Hospital, Jianyang, Sichuan, People's Republic of China
| | - Guoqiang Tang
- Department of Anesthesiology, First People's Hospital, Zigong, Sichuan, People's Republic of China
| | - Guanghong He
- Department of Anesthesiology, First People's Hospital, Zigong, Sichuan, People's Republic of China
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Chalissery AJ, Gaughan M, Haughton G, Mullins G, Delanty N. Teaching Video NeuroImages: Vagoglossopharyngeal neuralgia mimicking a seizure. Neurology 2019; 90:e1179. [PMID: 29581336 DOI: 10.1212/wnl.0000000000005211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Albi J Chalissery
- From the Departments of Neurology (A.J.C., M.G., N.D.) and Neurophysiology (G.H., G.M.), Beaumont Hospital, Dublin, Ireland.
| | - Maria Gaughan
- From the Departments of Neurology (A.J.C., M.G., N.D.) and Neurophysiology (G.H., G.M.), Beaumont Hospital, Dublin, Ireland
| | - Geoffrey Haughton
- From the Departments of Neurology (A.J.C., M.G., N.D.) and Neurophysiology (G.H., G.M.), Beaumont Hospital, Dublin, Ireland
| | - Gerard Mullins
- From the Departments of Neurology (A.J.C., M.G., N.D.) and Neurophysiology (G.H., G.M.), Beaumont Hospital, Dublin, Ireland
| | - Norman Delanty
- From the Departments of Neurology (A.J.C., M.G., N.D.) and Neurophysiology (G.H., G.M.), Beaumont Hospital, Dublin, Ireland
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30
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Perez-Roman RJ, Chen SH, Sur S, Leon-Correa R, Morcos JJ. A Unique Case of Microvascular Triple Decompression for Combined Simultaneous Trigeminal Neuralgia, Hemifacial Spasm, and Glossopharyngeal Neuralgia Because of the Dolichoectatic Vertebrobasilar System. Oper Neurosurg (Hagerstown) 2019; 18:692-697. [DOI: 10.1093/ons/opz205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/16/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GPN) are hyperactive dysfunction syndromes (HDS) commonly caused by microvascular compression of their root entry zone. Cases of combined HDS involving 2 or more of these entities are extremely rare. Although microvascular decompression is the surgical treatment of choice, there are additional techniques that have been described as efficient methods to accomplish vessel transposition.
OBJECTIVE
To our knowledge, we present the first reported case of triple simultaneous HDS successfully treated using the clip-sling technique to achieve microvascular decompression. We discuss several technical pearls and pitfalls relevant to the use of the sling suspension technique.
METHODS
We report the rare case of a 66-yr-old male with combined simultaneous unilateral right-sided TN, HFS, and GPN because of a dolichoectatic vertebrobasilar system compressing the exit zones of the right trigeminal, facial, and glossopharyngeal nerves and present a literature review of combined HDS and their different surgical treatments.
RESULTS
Symptomatic TN, HFS, and GPN have been reported 8 times in the literature with our case being the ninth. A retrosigmoid craniotomy was performed for microvascular decompression of the brainstem with a clip-sling suspension technique augmented with Teflon felt pledgets. The patient had immediate complete relief from TN, HFS, and GPN postoperatively.
CONCLUSION
Microvascular decompression using the clip-sling technique via a retrosigmoid approach should be considered as a safe and effective option for transposition and suspension of the offending artery and decompression of the affected nerve roots in cases of combined HDS.
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Affiliation(s)
- Roberto J Perez-Roman
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Stephanie H Chen
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Samir Sur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Roberto Leon-Correa
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jacques J Morcos
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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31
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Simpson CD, Rahman N, Lamey PJ. Glossopharyngeal neuralgia: a case report. Br J Oral Maxillofac Surg 2019; 57:486-487. [PMID: 31076219 DOI: 10.1016/j.bjoms.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/08/2019] [Indexed: 11/20/2022]
Affiliation(s)
- C D Simpson
- Department of Oral Surgery, Edinburgh Dental Institute, UK.
| | - N Rahman
- Department of Oral Surgery, Edinburgh Dental Institute, UK.
| | - P-J Lamey
- Department of Oral Medicine, Edinburgh Dental Institute, UK.
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The neurosurgical treatment of craniofacial pain syndromes: current surgical indications and techniques. Neurol Sci 2019; 40:159-168. [DOI: 10.1007/s10072-019-03789-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Vgontzas A, Rizzoli PB. Nonmigraine Headache and Facial Pain. Med Clin North Am 2019; 103:235-250. [PMID: 30704679 DOI: 10.1016/j.mcna.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The vast majority of headache patients encountered in the outpatient general medicine setting will be diagnosed with a primary headache disorder, mostly migraine or tension-type headache. Other less common primary headaches and secondary headaches, related to or caused by another condition, are the topic of this article. Nonmigraine primary headaches include trigeminal autonomic cephalalgias, primarily cluster headache; facial pain, primarily trigeminal neuralgia; and miscellaneous headache syndromes, such as hemicrania continua and new daily persistent headache. Selected secondary headaches related to vascular disease, cerebrospinal fluid dynamics, and inflammatory conditions are also reviewed.
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Affiliation(s)
- Angeliki Vgontzas
- Department of Neurology, Brigham and Women's Hospital, John R. Graham Headache Center, Brigham and Women's Faulkner Hospital, Harvard Medical School, 1153 Centre Street, Suite 4H, Boston, MA 02130, USA
| | - Paul B Rizzoli
- Department of Neurology, Brigham and Women's Hospital, John R. Graham Headache Center, Brigham and Women's Faulkner Hospital, Harvard Medical School, 1153 Centre Street, Suite 4H, Boston, MA 02130, USA.
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Mascarenhas RJ, Hapangama ND, Mews PJ, Burlakoti A, Ranjitkar S. Orofacial neuralgia associated with a middle cerebral artery aneurysm. Aust Dent J 2018; 64:106-110. [PMID: 30525205 DOI: 10.1111/adj.12668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2018] [Indexed: 12/01/2022]
Abstract
Chronic orofacial pain of neuropathic origin can present diagnostic and management dilemmas to dental practitioners and also affects the patient's quality of life. Intracranial aneurysms are a potential cause of stroke (e.g. sub-arachnoid haemorrhage) that is usually associated with, high rates of mortality and morbidity. A patient who had been previously managed for symptoms of temporomandibular joint disorder (TMD) presented with sharp, shooting pain of moderate intensity. It was precipitated by swallowing, and radiated to the right throat, posterior border of the mandible, ear and temporomandibular joint. Clinical and radiological investigations ruled out odontogenic pain, TMD and other more common types of facial pain. Magnetic resonance imaging revealed a 7 × 6 mm aneurysm in the right middle cerebral artery (MCA) which was subsequently surgically clipped. Interestingly, the facial pain resolved after this procedure. Compression of the insular region of the brain innervated by the trigeminal, glossopharyngeal and vagus nerves provides a plausible explanation for the pain reported. To our knowledge, this is the first case of facial neuralgia associated with an aneurysm in the MCA which emphasizes the importance of a multidisciplinary approach in the diagnosis and management of unusual cases of chronic orofacial pain.
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Affiliation(s)
- R J Mascarenhas
- School of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - N D Hapangama
- Oral and Maxillofacial Surgery Unit, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - P J Mews
- ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - A Burlakoti
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - S Ranjitkar
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
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Recommandations pour le diagnostic et la prise en charge de la névralgie trigéminale classique. Neurochirurgie 2018; 64:285-302. [DOI: 10.1016/j.neuchi.2018.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 03/20/2018] [Accepted: 04/08/2018] [Indexed: 12/26/2022]
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Abstract
PURPOSE OF REVIEW Neuralgias are characterized by pain in the distribution of a cranial or cervical nerve. Typically, they are brief, paroxysmal, painful attacks, although continuous neuropathic pain may occur. The most commonly encountered conditions are trigeminal, postherpetic, and occipital neuralgia. Less common neuralgias include glossopharyngeal, superior laryngeal, auriculotemporal, and nervus intermedius neuralgia, among others. The approach to diagnosis and treatment of this group of disorders is reviewed. RECENT FINDINGS Recent guidelines of medication administration, the use of botulinum toxin, and more targeted procedures have improved treatment of neuralgias. Patients who present with neuralgias should have imaging studies to investigate for structural abnormalities unless the etiology is apparent. Management of both common and rare neuralgias can be challenging and is best guided by the most recent available evidence.
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Affiliation(s)
- Danielle Wilhour
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Stephanie J Nahas
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Jani RH, Hughes MA, Ligus ZE, Nikas A, Sekula RF. MRI Findings and Outcomes in Patients Undergoing Microvascular Decompression for Glossopharyngeal Neuralgia. J Neuroimaging 2018; 28:477-482. [PMID: 30102011 DOI: 10.1111/jon.12554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/23/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Ronak H Jani
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marion A Hughes
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Radiology, Pittsburgh, Pennsylvania, USA
| | - Zachary E Ligus
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alexandra Nikas
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Raymond F Sekula
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Neurological Surgery, Pittsburgh, Pennsylvania, USA
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Abstract
Neuropathic pain of the orofacial region can cause much distress in individuals presenting with this condition. It may be easily mistaken for dental pain, and hence many individuals may undergo unnecessary dental work. Knowledge of the types of neuropathic orofacial pain may assist in timely diagnosis and improvement of a patient's quality of life.
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Ganaha S, Grewal SS, Cheshire WP, Reimer R, Quiñones-Hinojosa A, Wharen RE. Surgical treatment of bilateral glossopharyngeal neuralgia. Int J Neurosci 2018; 128:1204-1206. [PMID: 29888997 DOI: 10.1080/00207454.2018.1486308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Glossopharyngeal neuralgia (GPN) is a condition characterised by sudden, severe pain in the distribution of the glossopharyngeal nerve. It can be triggered by talking, yawning, coughing and swallowing. Classically, patients experience a unilateral lancinating and excruciating pain described as electrical shock-like pain in the areas around the ear, tongue, or the mandibular angle. Uncommon manifestations include cardiac arrhythmias and syncope during pain episodes. Surgery is indicated in refractory cases. Bilateral GPN is rare, and definitive surgical treatment for bilateral GPN has not yet been reported. In this case report, a young woman with bilateral GPN who underwent staged surgery bilaterally is described. She did not develop life-threatening cardiac abnormalities postoperatively.
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Affiliation(s)
- Sara Ganaha
- a Department of Neurosurgery , Mayo Clinic , Jacksonville , FL , USA
| | - Sanjeet S Grewal
- a Department of Neurosurgery , Mayo Clinic , Jacksonville , FL , USA
| | | | - Ronald Reimer
- a Department of Neurosurgery , Mayo Clinic , Jacksonville , FL , USA
| | | | - Robert E Wharen
- a Department of Neurosurgery , Mayo Clinic , Jacksonville , FL , USA
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Franzini A, Messina G, Franzini A, Marchetti M, Ferroli P, Fariselli L, Broggi G. Treatments of glossopharyngeal neuralgia: towards standard procedures. Neurol Sci 2018; 38:51-55. [PMID: 28527060 DOI: 10.1007/s10072-017-2909-6] [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] [Indexed: 11/29/2022]
Abstract
The degree of disability due to glossopharyngeal neuralgia (GN) refractory to conservative treatments justifies surgical procedures as second-line treatments. Since the first description of this facial pain disorders, many surgical options have been described either via a percutaneous or an open surgical way. Actually, when a neurovascular conflict on root entry zone (REZ) or cisternal portion of the ninth and tenth cranial nerves is identified, microvascular decompression (MVD) is the first surgical option to consider. Many studies have demonstrated its efficacy and safety for the treatment of GN. Recently, stereotactic radiosurgery has gained space in the treatment of selected cases of GN. We provide an overview of the surgical procedures for the treatment of GN and of our own experience.
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Affiliation(s)
- Andrea Franzini
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Giuseppe Messina
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Angelo Franzini
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Marcello Marchetti
- Radiosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Laura Fariselli
- Radiosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Broggi
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
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Abstract
Challenging to diagnose and manage, orofacial pain is a common and costly problem with a profound effect on quality of life. Delayed diagnosis and management can lead to prolonged patient suffering and disability. This article describes the background, assessment, differential diagnosis, management, and referral of patients with orofacial pain.
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Abstract
Background We report the first literature description of ictal epileptic headaches closely mimicking glossopharyngeal neuralgia and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. Case 1 A 37-year-old man complained of short-lasting, electric-shock like headache, confined to the pharynx. During the episodes, he could not speak because he felt “words blocked at the throat”. An EEG recorded epileptic discharges concomitant with headache; a brain MRI disclosed frontal polymicrogyria. Case 2 A 66-year-old man complained of short-lasting, right periocular headache, associated with ipsilateral ptosis, conjunctival injection and lacrimation. Some episodes were followed by tonic contraction of the right facial and limb muscles; on one occasion, headache was followed by a generalized seizure. A brain MRI revealed hippocampal abnormalities. Discussion These cases highlight the complex relationship between headache and epilepsy, and suggest a possible contribution of cortical structures to the genesis of paroxysmal headaches such as glossopharyngeal neuralgia and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing.
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Affiliation(s)
- Arens Taga
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- Dipartimento di Emergenza-Urgenza, ed Area Medica Generale e Specialistica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Irene Florindo
- Dipartimento di Emergenza-Urgenza, ed Area Medica Generale e Specialistica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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Ball K, Vacek TP. Use of Selective Serotonin Reuptake Inhibitor and Midodrine in a Patient With Autonomic Instability 2/2 Compressive Squamous Cell Carcinoma and Pain. J Investig Med High Impact Case Rep 2018; 6:2324709617749621. [PMID: 29404375 PMCID: PMC5791471 DOI: 10.1177/2324709617749621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 11/19/2017] [Accepted: 11/21/2017] [Indexed: 11/15/2022] Open
Abstract
A rare cause of reflex syncope is metastatic cancers involving the head and neck. These can irritate the glossopharyngeal nerve and lead to glossopharyngeal neuralgia with associated syncope. This type of syncope is difficult to treat since it commonly involves both a vasodepressor and cardioinhibitory response, and typically requires removal of the irritative focus. We report a case of a 52-year-old male who presented from home with syncope. He endorsed a 5-week history of progressively worsened positional headaches and dramatic 40-pound weight loss with night sweats over 6 months. In the emergency department, his heart rate was noted to drop into the 20s with associated hypotension 60/31 mm Hg. Heart rate and blood pressure increased with intravenous atropine. Physical examination revealed a large ulcerative lesion in the left tonsillar area. After biopsy of the lesion, a diagnosis of stage IV squamous cell carcinoma of the neck was made; computed tomography angiogram and positron emission tomography/computed tomography confirmed involvement in the posterior tongue extending to the left palatine tonsil in addition to the left jugular chain. The patient was started on cisplatin and radiation therapy, but continued to have episodes of syncope associated with bradycardia and hypotension. After a failed trial of benztropine, the patient was started on sertraline and midodrine with resolution of syncope. This could be a potential treatment option in those with compressive mixed syncope who are not candidates for surgery or chemotherapy or are awaiting definitive treatment.
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Affiliation(s)
- Kyle Ball
- Wright State University, Dayton, OH, USA
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44
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Schuster NM, Hsia-Kiung ME. Glossopharyngeal Postherpetic Neuralgia Palliated With Fluoroscopic-Guided Nerve Block: A Case Report. Headache 2017; 58:154-156. [PMID: 28925505 DOI: 10.1111/head.13192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/04/2017] [Accepted: 06/21/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Nathaniel M Schuster
- Center for Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maximilian E Hsia-Kiung
- Center for Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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45
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Cao J, Jiao J, Du Z, Xu W, Sun B, Li F, Liu Y. Combined Hyperactive Dysfunction Syndrome of the Cranial Nerves: A Retrospective Systematic Study of Clinical Characteristics in 44 Patients. World Neurosurg 2017; 104:390-397. [PMID: 28512048 DOI: 10.1016/j.wneu.2017.05.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Combined hyperactive dysfunction syndrome (HDS) is defined as the combination symptoms arising from overactivity in cranial nerves, specifically, trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GPN), without an obvious explanatory structural lesion. This study retrospectively analyzes the clinical characteristics of combined HDS treated with microvascular decompression (MVD) in a single institution. METHODS A total of 1450 patients with HDS were treated with MVD in our department during a 10-year period, among which 44 cases of combined HDS were identified. Clinical records and follow-ups were reviewed. RESULTS Combined HDS comprised 3.03% (44/1450) of all HDS in our series, with female predominance compared with single HDS (P = 0.002), including combined TN-HFS (14 cases), combined TN-GPN (26 cases), bilateral TN (2 cases), and combined TN-HFS-GPN (2 cases). The average age at diagnosis of patients with combined HDS (60.9 years) was significantly older than that of patients with single HDS (53.5 years) (P = 0.035). Hypertension was closely associated with the prevalence of combined HDS compared with single HDS (P = 0.009). The curative rate was 97.7% (43/44) after MVD, and the recurrence rate was 3.33%. The incidence rates of postoperative cardiac, pulmonary, thromboembolic, and delirium complications were higher in combined HDS than in single HDS (P < 0.05). CONCLUSIONS Combined HDS is a rarely occurring syndrome usually observed in older females, and the most common types are combined TN-GPN and combined TN-HFS. Age and gender seemed to be causes for developing combined HDS, and MVD shows potential as a favorable treatment choice.
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Affiliation(s)
- Jingwei Cao
- Department of Neurosurgery, Qilu Hospital and Brain Science Research Institute of Shandong University, Shandong, People's Republic of China; Department of Neurosurgery, Qilu Children's Hospital of Shandong University, Shandong, People's Republic of China
| | - Jie Jiao
- Department of Medicine, Shandong University, Shandong, People's Republic of China
| | - Zhenhui Du
- Department of Neurosurgery, Qilu Hospital and Brain Science Research Institute of Shandong University, Shandong, People's Republic of China
| | - Wenzhe Xu
- Department of Neurosurgery, Qilu Hospital and Brain Science Research Institute of Shandong University, Shandong, People's Republic of China
| | - Bin Sun
- Department of Neurosurgery, Qilu Hospital and Brain Science Research Institute of Shandong University, Shandong, People's Republic of China
| | - Feng Li
- Department of Neurosurgery, Qilu Hospital and Brain Science Research Institute of Shandong University, Shandong, People's Republic of China.
| | - Yuguang Liu
- Department of Neurosurgery, Qilu Hospital and Brain Science Research Institute of Shandong University, Shandong, People's Republic of China.
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46
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French guidelines for diagnosis and treatment of classical trigeminal neuralgia (French Headache Society and French Neurosurgical Society). Rev Neurol (Paris) 2017; 173:131-151. [DOI: 10.1016/j.neurol.2016.12.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 12/19/2016] [Indexed: 12/19/2022]
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Abstract
Premise In this article we review some lesser known cranial neuralgias that are distinct from trigeminal neuralgia, trigeminal autonomic cephalalgias, or trigeminal neuropathies. Included are occipital neuralgia, superior laryngeal neuralgia, auriculotemporal neuralgia, glossopharyngeal and nervus intermedius neuralgia, and pain from acute herpes zoster and postherpetic neuralgia of the trigeminal and intermedius nerves. Problem Facial neuralgias are rare and many physicians do not see such cases in their lifetime, so patients with a suspected diagnosis within this group should be referred to a specialized center where multidisciplinary team diagnosis may be available. Potential solution Each facial neuralgia can be identified on the basis of clinical presentation, allowing for precision diagnosis and planning of treatment. Treatment remains conservative with oral or topical medication recommended for neuropathic pain to be tried before more invasive procedures are undertaken. However, evidence for efficacy of current treatments remains weak.
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Affiliation(s)
- Francis O'Neill
- 1 Department of Oral Surgery, Liverpool University Dental Hospital, Liverpool, UK.,2 Pain Research Institute, Clinical Sciences Centre, Fazakerley, Liverpool, UK
| | - Turo Nurmikko
- 2 Pain Research Institute, Clinical Sciences Centre, Fazakerley, Liverpool, UK.,3 Neuroscience Research, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Claudia Sommer
- 4 Department of Neurology, University of Würzburg, Germany
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48
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Watanabe K, Tubbs RS, Satoh S, Zomorodi AR, Liedtke W, Labidi M, Friedman AH, Fukushima T. Isolated Deep Ear Canal Pain: Possible Role of Auricular Branch of Vagus Nerve—Case Illustrations with Cadaveric Correlation. World Neurosurg 2016; 96:293-301. [DOI: 10.1016/j.wneu.2016.08.102] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 11/28/2022]
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49
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Maher T, Shankar H. Ultrasound-Guided Peristyloid Steroid Injection for Eagle Syndrome. Pain Pract 2016; 17:554-557. [DOI: 10.1111/papr.12497] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/02/2016] [Accepted: 06/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Timothy Maher
- Department of Anesthesiology; Medical College of Wisconsin; Milwaukee Wisconsin U.S.A
| | - Hariharan Shankar
- Department of Anesthesiology; Medical College of Wisconsin; Milwaukee Wisconsin U.S.A
- Clement Zablocki VA Medical Center; Milwaukee Wisconsin U.S.A
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50
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Kermani H, Dehghani N, Aghdashi F, Esmaeelinejad M. Nonsyndromic Isolated Temporal Bone Styloid Process Fracture. Trauma Mon 2016; 21:e24395. [PMID: 27218052 PMCID: PMC4869430 DOI: 10.5812/traumamon.24395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 01/07/2015] [Accepted: 05/12/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction: Fracture of the styloid process (SP) of the temporal bone is a rare traumatic injury in normal individuals who are not suffering from Eagle’s syndrome. Diagnosis and management of this problem requires comprehensive knowledge about its signs and symptoms. This study aimed to present an isolated styloid process fracture in a nonsyndromic patient. Case Presentation: A 50-year-old male patient was referred to our department with a complaint of sore throat. However, presentation of the problem resembled the symptoms of temporomandibular joint disorder (TMD). Fracture of the SP of the temporal bone was detected on the radiographs. Conservative treatment was undertaken for the patient. The symptoms diminished after about four months. Conclusions: Physicians should be aware of the signs and symptoms of different pain sources to prevent misdiagnosis and maltreatment.
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Affiliation(s)
- Hamed Kermani
- Department of Oral and Maxillofacial Surgery, Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Nima Dehghani
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Farzad Aghdashi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Esmaeelinejad
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohammad Esmaeelinejad, Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166050480, Fax: +98-2122439976, E-mail:
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