Glossopharyngeal neuralgia treated using stereotactic Gamma Knife radiosurgery

Abstract

Glossopharyngeal neuralgia (GPN) is a rare disorder of the ninth cranial nerve. It affects patients' quality of life, with the characteristic symptoms of severe paroxysmal pain affecting the throat, tongue, and ear. Traditional treatment for GPN includes medical management with anticonvulsants and analgesics and surgery with microvascular decompression (MVD) for refractory cases. However, surgical complications such as neurovascular damage may occur. Gamma knife radiosurgery (GKRS) might be a viable surgical alternative for idiopathic GPN. Although GKRS is widely recognized as an effective and minimally invasive treatment for intractable trigeminal neuralgia, its role in GPN has not yet been clearly determined. Herein, we report a 45-year-old male patient who presented with the left throat intractable shooting pain for 6 months. The pain also radiated to his left ear and was triggered by swallowing. He was diagnosed as having GPN. The patient refused for MVD treatment. Thus, we instead performed GKRS. The target was placed over the cisternal segment of the glossopharyngeal nerve, close to the meatus of the jugular foramen, with a single 4-mm isocenter. The maximal dose to the target was 86 Gy. The patient's pain completely disappeared 2-week posttreatment. No major neurological complication was noted in series follow-up. The clinical response in this case report provides evidence of the efficacy of treating GPN with stereotactic radiosurgery. GKRS is a valuable surgical alternative for idiopathic GPN, with very high efficacy and without permanent complications. Additional studies with larger numbers of patients are needed to demonstrate the long-term safety and effectiveness for this treatment.