RESUMO
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.
Assuntos
Doenças do Nervo Glossofaríngeo , Neuralgia do Trigêmeo , Humanos , Doenças do Nervo Glossofaríngeo/diagnóstico , Doenças do Nervo Glossofaríngeo/terapia , Neuralgia do Trigêmeo/diagnóstico , Neuralgia do Trigêmeo/terapia , Nervos CranianosRESUMO
Background: A woman in her forties developed intermittent pain in her ear and pharynx which worsened when talking and swallowing. Multidisciplinary approach confirmed a rare diagnosis. Case presentation: The patient reported left-sided ear fullness, followed by otalgia and burning pain in the palate. Numbness in the palate and nasal cavity, and soreness upon palpation of the external ear canal were noted upon examination. Magnetic resonance imaging (MRI) with contrast showed a vessel located in close proximity to the glossopharyngeal nerve on the left side. A diagnosis of glossopharyngeal neuralgia was made, and the patient was treated with antiepileptic medications without substantial effect. Microvascular decompression of the glossopharyngeal nerve was therefore performed. A large vein located along the glossopharyngeal nerve was separated and fixated away from the nerve. The patient reported pain alleviation after the operation, which has continued to improve on follow-ups. Interpretation: Glossopharyngeal neuralgia is a rare condition characterised by intermittent, unilateral pain in the base of the tongue, oropharynx, and/or angle of the mandible which radiates to the ipsilateral ear. The condition should be treated medically, but open surgical treatment should be considered in refractory cases. Early diagnosis and treatment are essential.
Assuntos
Dor Crônica , Doenças do Nervo Glossofaríngeo , Feminino , Humanos , Anticonvulsivantes , Dor de Orelha/etiologia , Doenças do Nervo Glossofaríngeo/diagnóstico , Doenças do Nervo Glossofaríngeo/etiologia , Doenças do Nervo Glossofaríngeo/cirurgia , Hipestesia , Adulto , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Microvascular decompression (MVD) is already the preferred surgical treatment for medically refractory neurovascular compression syndromes (NVC) such as hemifacial spasm (HFS), trigeminal neuralgia (TN), and glossopharyngeal neuralgia (GPN). Endoscopy has significantly advanced surgery and provides enhanced visualization of MVD. The aim of this study is to analyze the efficacy and safety of fully endoscopic microvascular decompression (E-MVD) for the treatment of HFS, TN, and GPN, as well as to present our initial experience. MATERIALS AND METHODS: This retrospective case series investigated fully E-MVD performed in 248 patients (123 patients with HFS, 115 patients with TN, and 10 patients with GPN ) from December 2008 to October 2021 at a single institution. The operation duration, clinical outcomes, responsible vessels, intra- and postoperative complications, and recurrences were recorded. Preoperative and immediate postoperative magnetic resonance imaging (MRI) and computerized tomography (CT) were performed for imageological evaluation. The Shorr grading and Barrow Neurological Institute (BNI) pain score were used to evaluate clinical outcomes. The efficacy, safety, and risk factors related to the recurrence of the operation were retrospectively analysed, and the surgical techniques of fully E-MVD were summarised. RESULTS: A total of 248 patients (103 males) met the inclusion criteria and underwent fully E-MVD were retrospectively studied. The effective rate of 123 patients with HFS was 99.1%, of which 113 cases were completely relieved and 9 cases were significantly relieved. The effective rate of 115 patients with TN was 98.9%, of which 105 cases had completely pain relieved after surgery, 5 cases had significant pain relieved, 4 cases had partial pain relieved but still needed to be controlled by medication. The effective rate of 10 patients with GPN was 100%, 10 cases of GPN were completely relieved after surgery. As for complications, temporary facial numbness occurred in 4 cases, temporary hearing loss in 5 cases, dizziness with frequent nausea and vomiting in 8 cases, headache in 12 cases, and no cerebral hemorrhage, intracranial infection, and other complications occurred. Follow-up ranged from 3 to 42 months, with a mean of 18.6 ± 3.3 months. There were 4 cases of recurrence of HFS and 11 cases of recurrence of TN. The other effective patients had no recurrence or worsening of postoperative symptoms. The cerebellopontine angle (CPA) area ratio (healthy/affected side), the length of disease duration, and the type of responsible vessels are the risk factors related to the recurrence of HFS, TN, and GPN treated by fully E-MVD. CONCLUSIONS: In this retrospective study, our results suggest that the fully E-MVD for the treatment of NVC such as HFS, TN, and GPN, is a safe and effective surgical method. Fully E-MVD for the treatment of NVC has advantages and techniques not available with microscopic MVD, which may reduce the incidence of surgical complications while improving the curative effect and reducing the recurrence rate.
Assuntos
Doenças do Nervo Glossofaríngeo , Espasmo Hemifacial , Cirurgia de Descompressão Microvascular , Neuralgia do Trigêmeo , Masculino , Humanos , Cirurgia de Descompressão Microvascular/efeitos adversos , Cirurgia de Descompressão Microvascular/métodos , Estudos Retrospectivos , Neuralgia do Trigêmeo/cirurgia , Neuralgia do Trigêmeo/complicações , Neuralgia do Trigêmeo/diagnóstico , Espasmo Hemifacial/cirurgia , Espasmo Hemifacial/etiologia , Doenças do Nervo Glossofaríngeo/cirurgia , Doenças do Nervo Glossofaríngeo/diagnóstico , Doenças do Nervo Glossofaríngeo/etiologia , Endoscopia , Cefaleia/etiologia , Resultado do TratamentoRESUMO
OBJECTIVES: Hyperactive dysfunction syndrome (HDS) is defined as symptoms arising from overactivities in cranial nerves, like trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GPN). A combination of these cranial nerve neuralgias, that might or might not occur in one or both sides, either synchronously, or metachronously is called combined hyperactive dysfunction syndrome (CHDS). CASE PRESENTATION: We presented a 73 years-old male patient with CHDS presenting with GPN as the initial symptom, with total relief from GPN, TN, and HFS after microvascular decompression. Up to date, only nine patients have been reported in the literature with symptomatic. CONCLUSIONS: TN-HFS-GPN. Our case is the first case with GPN as the initial symptom. The combination of arterial and venous origin of the offending vessels makes the case picturesage.
Assuntos
Doenças do Nervo Glossofaríngeo , Espasmo Hemifacial , Cirurgia de Descompressão Microvascular , Neuralgia , Neuralgia do Trigêmeo , Humanos , Masculino , Idoso , Doenças do Nervo Glossofaríngeo/diagnóstico , Doenças do Nervo Glossofaríngeo/etiologia , Doenças do Nervo Glossofaríngeo/cirurgia , Nervos Cranianos/cirurgia , Neuralgia do Trigêmeo/diagnóstico , Neuralgia do Trigêmeo/etiologia , Neuralgia do Trigêmeo/cirurgia , Neuralgia/cirurgia , Espasmo Hemifacial/cirurgia , Nervo Glossofaríngeo/cirurgiaRESUMO
Neurovascular compression syndrome is caused by vessels touching a cranial nerve, resulting in clinical manifestations of abnormal sensory or motor symptoms. The most common manifestations are trigeminal neuralgia and hemifacial spasm. However, neurovascular compression of the vestibular nerve or glossopharyngeal nerve are rare. In this article, we describe four typical cases of neurovascular compression syndrome. In addition, we analyze the main features of the etiology, neuroimaging, and treatment of this disease.
Assuntos
Doenças do Nervo Glossofaríngeo , Espasmo Hemifacial , Síndromes de Compressão Nervosa , Neuralgia do Trigêmeo , Nervos Cranianos , Doenças do Nervo Glossofaríngeo/diagnóstico , Espasmo Hemifacial/diagnóstico , Humanos , Síndromes de Compressão Nervosa/complicações , Síndromes de Compressão Nervosa/diagnóstico , Neuralgia do Trigêmeo/diagnóstico , Neuralgia do Trigêmeo/etiologiaRESUMO
Resumen La amigdalectomía es uno de los procedimientos quirúrgicos más frecuentes que realiza el otorrinolaringólogo. Dentro de las complicaciones posoperatorias, la neuralgia del nervio glosofaríngeo es extremadamente poco frecuente. En este artículo se presentan dos casos clínicos pediátricos con neuralgia del glosofaríngeo posamigdalectomía que fueron resueltos con tratamiento médico.
Abstract Tonsillectomy is one of the most common procedures done by the otolaryngologist. Among post-operative complications, the glossopharyngeal neuralgia is extremely uncommon. This article presents two pediatric clinical cases with post-tonsillectomy glossopharyngeal neuralgia that were resolved with medical treatment.
Assuntos
Humanos , Pré-Escolar , Complicações Pós-Operatórias , Tonsilectomia/efeitos adversos , Doenças do Nervo Glossofaríngeo , Doenças do Nervo Glossofaríngeo/diagnóstico , Nervo Glossofaríngeo , NeuralgiaRESUMO
Chronic neuropathic orofacial pain along with physical suffering can cause emotional, psychological and social difficulties, which significantly affects the quality of life of patients. Pain in the area of glossopharyngeal nerve innervation, especially chronic neuropathic, is relatively rare, but is significant because of the great suffering it causes to sufferers. It can be life threatening, due to the cardiac arrhythmia, syncope or convulsions it can cause. Drug treatment is often of limited effectiveness and can be fraught with side effects. It is necessary to look for the etiology of the underlying disease, and if possible, to take adequate causal treatment. This review article discusses the etiology, clinical features, differential diagnosis, and treatment modalities of neuropathic pain in the area of glossopharyngeal nerve innervation.
Assuntos
Doenças do Nervo Glossofaríngeo , Neuralgia , Humanos , Nervo Glossofaríngeo , Doenças do Nervo Glossofaríngeo/complicações , Doenças do Nervo Glossofaríngeo/diagnóstico , Qualidade de Vida , Dor Facial/etiologiaRESUMO
Retrosigmoid craniotomy for microvascular decompression (MVD) has been traditionally performed via craniectomy. Various closure techniques have been described, yet factors associated with wound-related complications remain undetermined. Accordingly, herein, we sought to identify risk factors associated with wound-related complications after such procedures. An institutional retrospective case-control study was performed; outcomes of interest were cerebrospinal fluid (CSF) leak, wound dehiscence, wound infection, and pseudomeningocele. Univariate analysis was performed using Wilcoxon rank sum test for non-parametric continuous outcomes and chi-square test for categorical outcomes. Multivariate logistic regression was performed on binomial outcome variables. The study population included 197 patients who underwent MVD for trigeminal neuralgia (83.2%), hemifacial spasm (12.2%), vestibular nerve section (3.0%), and glossopharyngeal neuralgia (1.5%). The overall wound-related complication rate was 14.2% (n = 28), including twelve patients (6.1%) with CSF leak, ten patients (5.1%) with wound infection, ten patients (5.1%) with pseudomeningocele, and nine (4.6%) patients with wound dehiscence. Using multivariate logistic regression, preoperative anemia and current tobacco use were associated with significantly higher rates of complications (OR 6.01 and 4.58, respectively; p < 0.05), including CSF leak (OR 12.83 and 12.40, respectively, p < 0.05). Of note, use of synthetic bone substitute for cranioplasty was associated with a significantly lower rate of complications (OR 0.13, p < 0.01). Preoperative anemia and current tobacco use significantly increased, while synthetic bone substitute cranioplasty significantly decreased, odds of wound-related complications, the need for treatment, and CSF leaks. Additionally, higher BMI, longer operative duration, and prior radiosurgery may increase risk for wound-related complications.
Assuntos
Vazamento de Líquido Cefalorraquidiano/diagnóstico , Vazamento de Líquido Cefalorraquidiano/etiologia , Craniotomia/efeitos adversos , Cirurgia de Descompressão Microvascular/efeitos adversos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Craniotomia/tendências , Feminino , Doenças do Nervo Glossofaríngeo/diagnóstico , Doenças do Nervo Glossofaríngeo/cirurgia , Espasmo Hemifacial/diagnóstico , Espasmo Hemifacial/cirurgia , Humanos , Masculino , Cirurgia de Descompressão Microvascular/tendências , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Neuralgia do Trigêmeo/diagnóstico , Neuralgia do Trigêmeo/cirurgiaAssuntos
Doenças dos Nervos Cranianos/diagnóstico , Herpes Zoster/diagnóstico , Mononeuropatias/diagnóstico , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/tratamento farmacológico , Doenças do Nervo Abducente/fisiopatologia , Doenças do Nervo Abducente/virologia , Idoso , Doenças dos Nervos Cranianos/tratamento farmacológico , Doenças dos Nervos Cranianos/fisiopatologia , Doenças dos Nervos Cranianos/virologia , Diagnóstico Diferencial , Diplopia/fisiopatologia , Dor de Orelha/fisiopatologia , Edema/fisiopatologia , Doenças do Nervo Facial/diagnóstico , Doenças do Nervo Facial/tratamento farmacológico , Doenças do Nervo Facial/fisiopatologia , Doenças do Nervo Facial/virologia , Paralisia Facial/fisiopatologia , Doenças do Nervo Glossofaríngeo/diagnóstico , Doenças do Nervo Glossofaríngeo/tratamento farmacológico , Doenças do Nervo Glossofaríngeo/fisiopatologia , Doenças do Nervo Glossofaríngeo/virologia , Glucocorticoides/uso terapêutico , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Neurossensorial/virologia , Herpes Zoster/tratamento farmacológico , Herpes Zoster/fisiopatologia , Humanos , Masculino , Mononeuropatias/tratamento farmacológico , Mononeuropatias/virologia , Osteomielite/diagnóstico , Otite Externa/diagnóstico , Prednisolona/uso terapêutico , Base do Crânio , Doenças do Nervo Vago/diagnóstico , Doenças do Nervo Vago/tratamento farmacológico , Doenças do Nervo Vago/fisiopatologia , Doenças do Nervo Vago/virologia , Doenças do Nervo Vestibulococlear/diagnóstico , Doenças do Nervo Vestibulococlear/tratamento farmacológico , Doenças do Nervo Vestibulococlear/fisiopatologia , Doenças do Nervo Vestibulococlear/virologia , Ativação ViralRESUMO
The present study evaluated the indications for microvascular decompression (MVD) in elderly patients based on the new classification of the elderly population proposed by the joint committee of the Japan Gerontological Society and the Japan Geriatrics Society in 2017.Retrospective analysis of 171 patients with hemifacial spasm (HFS), trigeminal neuralgia (TN), and glossopharyngeal neuralgia (GPN) who underwent MVD in 2018. Patients were divided into three groups based on the proposal: old group, 75-89 years; pre-old group, 65-74 years; and not-old group, 64 years or younger. Preoperative comorbidities were divided into five types and the American Society of Anesthesiologists Physical Status (ASA-PS) was recorded. Outcome of the surgery and neurological complications were evaluated in June 2019.No decrease in activity of daily living occurred in any patient and surgical results showed no difference among the three groups. Rate of preoperative cardiovascular diseases was higher in both the pre-old and old groups compared with the not-old group (p <0.001 and Cramer V = 0.429). In terms of ASA-PS classification, only ASA-PS I and II were found, and rate of ASA-PS II was higher in the pre-old and old groups compared with the not-old group (p <0.001 and Cramer V = 0.407). Some patients suffered from elevated blood pressure after surgery, but were successfully managed.In conclusion, MVD for elderly patients can be achieved safely with careful patient selection and perioperative management. Data should be continuously accumulated for the future development of decision-making algorithm for MVD in the elderly.
Assuntos
Doenças do Nervo Glossofaríngeo/cirurgia , Espasmo Hemifacial/cirurgia , Cirurgia de Descompressão Microvascular , Seleção de Pacientes , Neuralgia do Trigêmeo/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Geriatria , Doenças do Nervo Glossofaríngeo/diagnóstico , Doenças do Nervo Glossofaríngeo/etiologia , Espasmo Hemifacial/diagnóstico , Espasmo Hemifacial/etiologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sociedades Médicas , Neuralgia do Trigêmeo/diagnóstico , Neuralgia do Trigêmeo/etiologiaRESUMO
The neurosurgical treatment of glossopharyngeal neuralgia includes microvascular decompression or rhizotomy of the nerve. When considering open section of the glossopharyngeal nerve, numerous authors have recommended additional sectioning of the 'upper rootlets' of the vagus nerve because these fibers can occasionally carry the pain fibers causing the patient's symptoms. Sacrifice of vagus nerve rootlets, however, carries the potential risk of dysphagia and dysphonia. In this study, the anatomy and physiology of the vagus nerve rootlets are characterized to provide guidance for surgical decision-making. Twelve patients who underwent posterior fossa craniotomy with intraoperative electrophysiological monitoring of the vagus nerve rootlets were included in this study. In the 7 patients with glossopharyngeal neuralgia, the clinical outcomes and complications were further analyzed. In half of the patients, electrophysiological data demonstrated pure sensory function in the rostral rootlet(s) of the vagus nerve and motor responses in its caudal rootlets. This orientation of the vagus nerve, with some pure sensory function in its most rostral rootlet(s), was defined as Type A. In the other half of patients, all vagus nerve rootlets (including the most rostral) had motor responses. This was defined as Type B. The surgical strategy was guided by whether the patient had a Type A or Type B vagus nerve. For those with Type B, no vagus nerve rootlets were sacrificed. None of the patients with glossopharyngeal neuralgia developed any permanent neurological deficits. We recommend intraoperative electrophysiological testing of the vagus nerve rootlets. If the testing reveals motor innervation in the rostral vagal rootlet (Type B), that rootlet may be decompressed but should not be sectioned to avoid a motor complication. Patients with pure sensory innervation of the rostral rootlet(s) (Type A) can have decompression or section of those rootlets without complication.
Assuntos
Doenças do Nervo Glossofaríngeo/cirurgia , Nervo Glossofaríngeo/anatomia & histologia , Nervo Glossofaríngeo/cirurgia , Procedimentos Neurocirúrgicos/métodos , Nervo Vago/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Nervo Glossofaríngeo/fisiologia , Doenças do Nervo Glossofaríngeo/diagnóstico , Humanos , Masculino , Cirurgia de Descompressão Microvascular/métodos , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Medição da Dor/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento , Nervo Vago/fisiologiaRESUMO
Glossopharyngeal neuralgia is an underreported condition characterized by discomfort elicited through involvement of the ninthcranial nerve. Triggering phenomena and associated vagal nerve involvement creates the potential for an unexpected clinical presentation. In this case report, we present a 60-year-old male who described a shock-like pain throughout his neck and jaw. The patient initially responded to carbamazepine but the clinical course was complicated by cardiac pauses with syncope requiring pacemaker implantation. Failure of pharmacologic treatment led to surgical intervention.
Assuntos
Analgésicos não Narcóticos , Carbamazepina , Doenças do Nervo Glossofaríngeo , Neuralgia , Analgésicos não Narcóticos/uso terapêutico , Carbamazepina/uso terapêutico , Nervo Glossofaríngeo , Doenças do Nervo Glossofaríngeo/diagnóstico , Doenças do Nervo Glossofaríngeo/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial , SíncopeAssuntos
Doenças do Nervo Glossofaríngeo/diagnóstico , Herpes Zoster/diagnóstico , Doenças do Nervo Vago/diagnóstico , Adulto , Feminino , Doenças do Nervo Glossofaríngeo/virologia , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/virologia , Doenças da Boca/diagnóstico , Doenças da Boca/virologia , Doenças Faríngeas/diagnóstico , Doenças Faríngeas/virologia , Doenças do Nervo Vago/virologiaRESUMO
BACKGROUND: Glossopharyngeal schwannomas are rare tumors. Clinical and radiologic presentation closely resembles those of vestibular schwannomas. Their clinical presentation varies from vestibulocochlear dysfunction to glossopharyngeal and vagal nerve dysfunction. CASE DESCRIPTION: We report a case of a small glossopharyngeal schwannoma presenting with intractable recurrent sudden episodes of vomiting that subsided after tumor resection. To our knowledge, this is the only case in the literature of glossopharyngeal schwannoma presenting with nerve irritation in the form of intractable emesis. CONCLUSIONS: Small glossopharyngeal schwannomas can present with irritative symptoms of the ninth cranial nerve causing vomiting refractory to medical treatment. Intracranial imaging should be considered in the investigation of unexplained intractable vomiting even if the gross neurologic examination is normal.