Salvage gamma knife surgery for recurrent glossopharyngeal neuralgia following microvascular decompression: a retrospect
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ORIGINAL ARTICLE - FUNCTIONAL NEUROSURGERY - PAIN
Salvage gamma knife surgery for recurrent glossopharyngeal neuralgia following microvascular decompression: a retrospective case series Songshan Chai 1 & Hao Xu 1,2 & Dongdong Xiao 1 & Jiajing Wang 1 & Yihao Wang 1 & Junjun Li 1 & Peng Fu 1 & Hendrik Pool 3 & Nanxiang Xiong 4 Received: 4 July 2020 / Accepted: 16 November 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract 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. Keywords Glossopharyngeal neuralgia . Gamma Knife surgery . Recurrence . Microvascular decompression
Introduction Songshan Chai and Hao Xu contributed equally to this work. This article is part of the Topical Collection on Functional Neurosurgery - Pain * Nanxiang Xiong [email protected] 1
Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
2
Department of Neurosurgery, General Hospital of the Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, China
3
Department of International Education, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
4
Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuhan 430071, Hubei, China
Glossopharyngeal neuralgia (GPN), a rare craniofacial disorder, is characterized by the sudden onset of severe, paroxystic stabbing pain affecting the throat, posterior tongue, tonsil fossa, or external ear canal, lasting seconds to minutes [4]. Though the exact pathogenesis remains unknown, idiopathic GPN is thought to result from a vascular comp
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