Salvage gamma knife surgery for recurrent glossopharyngeal neuralgia following microvascular decompression: a retrospective case series.

BACKGROUND: Although microvascular decompression (MVD) is recognized as the preferred therapy for drug-resistant idiopathic glossopharyngeal neuralgia (GPN), the management of recurrent GPN following MVD is seldom mentioned in the current literature. This study aims to demonstrate the efficacy and safety of salvage Gamma Knife surgery (GKS) in the treatment of recurrent GPN after MVD. METHODS: From October 2012 to January 2018, seven patients (three males and four females) underwent salvage GKS for recurrent GPN following MVD, including two patients who received repeat GKS due to pain recurrence after their initial GKS salvage. The median age was 69 years (range 49-81 years) at first GKS and 72 years (67 years; 77 years) at second GKS. The delivered dose was 80 or 90 Gy at first GKS and 90 Gy at second GKS. Pain outcome was assessed according to the Barrow Neurological Institute (BNI) score. RESULTS: The median duration of follow-up after first GKS was 68 months (range 29-89 months) and 45 months (56 months; 33 months) after second GKS. The median time to pain response was 24 days (range, 6-80 days). One patient experienced palatoglossal hyperesthesia after first GKS, and no complications were noted after second GKS. At the last follow-up, 4 patients were BNI I, 1 was BNI II, and 2 was BNI IIIa. CONCLUSIONS: Salvage GKS is safe and effective for treating recurrent GPN after MVD, even for patients who experienced pain recurrence following their initial GKS salvage.

The outcomes of a second and third Gamma Knife radiosurgery for recurrent essential glossopharyngeal neuralgia.

INTRODUCTION: Gamma Knife radiosurgery (GKR) is a minimally invasive surgical option for drug-resistant essential glossopharyngeal neuralgia (GPN). The authors reviewed pain outcomes and complications in GPN patients who underwent a second or a third GKR for recurrent or persistent pain. METHODS: A retrospective review of all patients treated in a single center (Marseille, France) since 2004 was performed. Median prescribed dose was 85 Gy (range 70-90 Gy) at second GKR and 85 Gy at third GKR. Clinical outcome was evaluated using the Barrow Neurological Institute (BNI) scale. RESULTS: Six patients (4 males, 2 females) underwent second or third GKR. The median age was 70.2 years (range 64-83 years) at second GKR and 79.8 years at third GKR. No patient had any previous surgery but GKR. Five cases had a neurovascular conflict. Median follow-up period was 12 months (range 10-94 months) after second GKR and 16 months after third GKR. The median delay to initial pain freedom response was 30 days (range 3-120 days). One patient experienced pharyngeal hypoesthesia after second GKR. After a third GKR, up to 16 months, no side effects were encountered. At the last follow-up, 3 patients were BNI I, 2 were BNI IIIa, and one did not have any improvement. CONCLUSIONS: Second GKR resulted in pain reduction with low risk of additional morbidity. In patients unsuitable for microvascular decompression, GKR as a repeat or third treatment for intractable GPN is safe and effective. Third GKR was not associated with any side effects up to 16 months after the procedure.

The emerging role of gamma knife radiosurgery in the management of glossopharyngeal neuralgia.

Glossopharyngeal neuralgia (GPN) represents a rare craniofacial disorder accounting for about 1% of all craniofacial pain syndromes. GPN shares several pathophysiologic and clinical features with the more common trigeminal neuralgia. Medical therapy and microvascular decompression, in case of vascular nerve compression, represented the mainstay of GPN management. Other ablative therapies have been reported to date; however, few data are available because of the rarity of this pain syndrome. Among the ablative procedures, gamma knife radiosurgery (GKRS) has been recently introduced in the management of GPN with good pain control and low complication rates. Authors performed a systematic review of the published literature about GKRS in the management of GPN. Radiosurgical treatment data, pain control and recurrence rate have been analysed and compared. GKRS represented a valuable and effective treatment option for the management of GPN. Pain control and complication rates are better than those reported by other ablative procedures and microvascular decompression; however, future studies should be focused on the long-term efficacy of GKRS.

Glossopharyngeal neuralgia treated by Gamma Knife radiosurgery: safety and efficacy through long-term follow-up.

OBJECTIVE Glossopharyngeal neuralgia (GPN) is a rare and disabling condition. Just as for trigeminal neuralgia, Gamma Knife radiosurgery (GKRS) is increasingly proposed as a therapeutic option for GPN. The purpose of this study was to assess long-term safety and efficacy of GKRS for this indication. METHODS From 2007 to 2015, 9 patients (4 male and 5 female) underwent a total of 10 GKRS procedures. All of the patients presented with GPN that was refractory to all medical treatment, and all had a long history of pain. One patient had previously undergone surgical microvascular decompression. In 5 cases, a neurovascular conflict had been identified on MRI. For the GKRS procedure, the glossopharyngeal nerve was localized on MRI and CT under stereotactic conditions. The target was located at the glossopharyngeal meatus of the jugular foramen. The dose administered to the nerve was 80 Gy in 3 procedures and 90 Gy in the others. Follow-up was planned for 3, 6, and 12 months after the procedure and annually thereafter. RESULTS Eight patients experienced an improvement in their pain. The median length of time from GKRS to symptom improvement in this group was 7 weeks (range 2-12 months). At the first follow-up, 6 patients were pain-free (pain intensity scores of I-III, based on an adaptation of the Barrow Neurological Institute scoring system for trigeminal neuralgia), including 4 patients who were also medication-free (I). One patient had partial improvement (IV) and 2 patients had no change. The mean duration of follow-up was 46 months (range 10-90 months). At the last follow-up 6 patients remained pain-free (pain scores of I-III), including 4 patients who were pain free with no medication (I). No side effect was observed. CONCLUSIONS Because of its safety and efficacy, GKRS appears to be a useful tool for treatment of GPN, including first-line treatment.

Stereotactic radiosurgery for idiopathic glossopharyngeal neuralgia: an international multicenter study.

OBJECTIVE The goal of this study was to evaluate the outcomes of Gamma Knife stereotactic radiosurgery (SRS) when used for patients with intractable idiopathic glossopharyngeal neuralgia. METHODS Six participating centers of the International Gamma Knife Research Foundation identified 22 patients who underwent SRS for intractable glossopharyngeal neuralgia between 1998 and 2015. The median patient age was 60 years (range 34-83 years). The median duration of symptoms before SRS was 46 months (range 1-240 months). Three patients had unsuccessful prior surgical procedures, including microvascular decompression (MVD) (n = 2) and balloon compression (n = 1). The radiosurgical target was the glossopharyngeal meatus. The median maximum dose was 80 Gy. RESULTS The median follow-up was 45 months after SRS (range 6-120 months). Twelve patients (55%) had < 4 years of follow-up. Thirteen patients (59%) had initial complete pain relief at a median of 12 days after SRS (range 1-60 days). Three patients (14%) had partial pain relief at a median of 70 days after SRS (range 60-90 days). Six patients (27%) had no pain relief. Among 16 patients with initial pain relief, 5 maintained complete pain relief without medication (Barrow Neurological Institute [BNI] pain intensity score Grade I), 1 maintained occasional pain relief without medication (BNI Grade II), 3 maintained complete pain relief with medication (BNI Grade IIIb), and 7 patients had pain recurrence at a median of 20 months after SRS (range 6-120 months). The rates of maintenance of adequate pain relief (BNI Grades I-IIIb) were 63% at 1 year, 49% at 2 years, 38% at 3 years, 38% at 5 years, and 28% at 7 years. When 7 patients without pain recurrence within 4 years of follow-up were excluded, the rates of maintenance of adequate pain relief were 38% at 5 years and 28% at 7 years. Ten patients required additional procedures (MVD, n = 4; repeat SRS, n = 5; glossopharyngeal nerve block, n = 1). Four of 5 patients who underwent repeat SRS maintained pain relief (BNI Grade I, n = 3; and BNI Grade IIIb, n = 1). No adverse effects of radiation were observed after a single SRS. Two patients developed hyperesthesia in the palatoglossal arch 5 and 8 months after repeat SRS, respectively. CONCLUSIONS Stereotactic radiosurgery for intractable, medically refractory glossopharyngeal neuralgia provided lasting pain reduction in 55% of patients after 1 or 2 SRS procedures. Patients who had a poor response or pain recurrence may require additional procedures such as repeat SRS, MVD, nerve blocks, or nerve section. No patient developed changes in vocal cord function or swallowing disorders after SRS in this study.

[Association between cerebrospinal fluid leakage and persistence of Sternberg's canal: coincidence or cause?]. / Asociación entre fístula de líquido cefalorraquídeo y persistencia del canal de Sternberg: ¿coincidencia o causa?

Endoscopic surgical techniques allow treating various pathological diseases of the cranial base, including cerebrospinal fluid leaks (CSF). These approaches have a high success rate and reduce surgical time and morbidity. However, when they are located in the lateral wall of the sphenoid, the surgery is more complex. In our case, the CSF appeared to be related with a Sternberg's canal. Predisposing factors were also associated with an extensive unilateral pneumatization of the sinus and benign intracranial hypertension. The closure of the leak was achieved using an endoscopic transethmoidal transpterygoid approach for proper exposition of the lateral wall of the sphenoid. After five years of monitoring, the patient has had no more episodes of rhinoliquorrhea.