[Pulsed radiofrequency treatment in idiopathic and secondary glossopharyngeal neuralgia: preliminary results in 2 cases]. / Tratamiento con radiofrecuencia pulsada en dos casos de neuralgia glosofaríngea idiopática y secundaria. Resultados preliminares.

OBJECTIVES: To describe the use of pulsed radiofrequency (PRF) to treat 2 cases of glossopharyngeal neuralgia, 1 idiopathic and 1 secondary. PATIENTS: The first case involved a man diagnosed with Hodgkin's lymphoma involving the tonsils and manifesting as glossopharyngeal neuralgia that was refractory to all treatment approaches tried, including opioids and neuromodulation. The second case involved a patient diagnosed with essential glossopharyngeal neuralgia that was also resistant to drug treatment. The PRF procedure was performed in the operating room on an outpatient basis, under fluoroscopic guidance and with conventional monitoring. No perioperative events were reported. RESULTS: The treatment was effective for both patients, leading to decreases in visual analog scale pain reports between 5 and 7 points that were maintained over 6 months, although improvement for the patient with essential neuralgia was less intense and of shorter duration. Overall self-reported improvement assessed subjectively 6 months after PRF was 75% for the patient with Hodgkin's lymphoma and 50% for the patient with essential neuralgia, for whom a second PRF procedure was scheduled. Neither patient suffered complications or side effects that were potentially attributable to the procedure. CONCLUSIONS: PRF seems to be a safe, effective approach to treating neuralgia of the glossopharyngeal nerve, whether the condition is essential or secondary to another process. It is possible that if the condition is secondary, the clinical response may be greater in intensity and last longer.

Tratamiento con radiofrecuencia pulsada en dos casos de neuralgia glosofaríngea idiopática y secundaria. Resultados preliminares / Pulsed radiofrequency treatment in idiopathic and secondary glossopharyngeal neuralgia: preliminary results in 2 cases

OBJETIVOS: Describir la utilidad de la radiofrecuencia pulsada (RFP)en el tratamiento de dos casos de neuralgia glosofaríngea, uno diopático y, otro, secundario. PACIENTES: El primer caso es un varón con diagnóstico de linfoma de Hodgkin amigdalar, manifestado como una neuralgia glosofaríngea refractario a diferentes estrategias terapéuticas ensayadas, incluidos fármacos opioides y neuromoduladores. El segundo caso es un paciente con diagnóstico de neuralgia glosofaríngea esencial, también rebelde al tratamiento farmacológico. El procedimiento se realizó en quirófano en régimen ambulante, bajo control fluoroscópico y monitorización convencional. No se registraron incidentes perioperatorios. RESULTADOS: Aunque en el caso de origen esencial la mejoría clínica fue de menor intensidad y duración, la RFP resultó eficaz en ambos casos, con descensos de la Escala Visual Analógica entre de 5 y 7 puntos que se mantuvieron a los 6 meses de aplicado el tratamiento. La mejo- ría subjetiva, valorada por los propios pacientes a los 6 meses de aplicada la RFP, fue de 75%en el Hodgkin y de 50%en la neuralgia esencial. En este paciente se realizará una nueva sesión de RFP, las próximas semanas. En ninguno de los dos casos se presentaron complicaciones o efec- tos secundarios potencialmente atribuibles a la RFP. CONCLUSIONES: La RFP parece una técnica eficaz y segura en el tratamiento de la neuralgia del nervio gloso- faríngeo, tanto en la de origen esencial como en las secundarias, si bien, es posible que en estas últimas la respuesta clínica sea de mayor intensidad y duración

OBJECTIVES: To describe the use of pulsed radiofrequency (PRF)to treat 2 cases of glossopharyngeal neuralgia,1 idiopathic and 1 secondary. PATIENTS: The first case involved a man diagnosed with Hodgkin ’s lymphoma involving the tonsils and manifesting as glossopharyngeal neuralgia that was refractory to all treatment approaches tried,including opioids and neuro- modulation. The second case involved a patient diagnosed with essential glossopharyngeal neuralgia that was also resistant to drug treatment. The PRF procedure was per- formed in the operating room on an outpatient basis, under fluoroscopic guidance and with conventional monitoring. No perioperative events were reported. RESULTS: The treatment was effective for both patients, leading to decreases in visual analog scale pain reports between 5 and 7 points that were maintained over 6 months, although improvement for the patient with essential neuralgia was less intense and of shorter duration. Overall self-reported improvement assessed subjectively 6 months after PRF was 75%for the patient with Hodgkin ’s lymphoma and 50%for the patient with essential neuralgia, for whom a second PRF procedure was scheduled. Neither patient suffered complications or side effects that were potentially attributable to the procedure. CONCLUSIONS: PRF seems to be a safe, effective approach to treating neuralgia of the glossopharyngeal nerve, whether the condition is essential or secondary to another process. It is possible that if the condition is secondary, the clinical response may be greater in intensity and last longer

Anaesthesia-related diplopia after cataract surgery.

BACKGROUND: We studied the incidence and clinical characteristics of persistent diplopia related to anaesthesia for cataract surgery in a general hospital. METHODS: This was a retrospective review of anaesthesia for 3587 cataract surgeries. Of all the cases of diplopia referred to the ocular motility clinic after cataract surgery, those involving anaesthesia-related diplopia lasting longer than 1 month were studied. RESULTS: During the study period, 3450 cataract surgeries were performed by phacoemulsification and 137 by extracapsular extraction. Retrobulbar block was used in 2024 cases, peribulbar block in 98, topical anaesthesia in 1420 and general anaesthesia in 43. Twenty-six cases of persistent diplopia were found (0.72% incidence), nine of which (0.25%) were considered to be related to anaesthetic factors; five of the latter involved the left eye. Five were caused by paresis of the inferior rectus muscle and three by fibrosis. In one patient, the inferior oblique muscle was affected. Anaesthesia was by retrobulbar block in eight cases (0.39%) and by peribulbar block in one. No diplopia was found in patients who had topical or general anaesthesia. Treatment was with surgery in two patients and with prisms in six. One patient continues to be studied. CONCLUSIONS: Persistent diplopia can occur after cataract surgery using retrobulbar block predominantly through direct damage to the inferior rectus muscle. The overall incidence of anaesthesia-related diplopia in this series was 0.25%.