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  • Pain Free Survival After Microvascular Decompression and Sectioning of the Vagoglossopharyngeal Nerve Complex in Glossopharyngeal Neuralgia

    Final Number:
    130

    Authors:
    Katherine Holste; Ahmed M.T. Raslan MBBS MCh; Kim J. Burchiel MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Glossopharyngeal neuralgia (GN) is a rare pain condition in which patients experience paroxysmal, lancinating throat pain. There are multiple surgical approaches to this disorder including microvascular decompression (MVD), sectioning of cranial nerves IX and the upper rootlets of X, or a combination of the two. The aim of this study was to examine the long term quality of life and pain free survival after both MVD and sectioning of the X/IX complex.

    Methods: A combined retrospective chart review and a quality of life telephone survey were performed to collect demographic information and long-term outcomes. Quality of life was assessed by a modified Barrow Neurological Institute Pain Intensity Score and a Brief Pain Inventory - Facial scale questionnaires. Kaplan-Meier analysis was done for pain free survival.

    Results: Seventeen patients had an MVD and/or sectioning of the IX/X complex. Eleven patients had compression of IX/X by the Posterior Inferior Cerebellar Artery, 1 by a vertebral artery and 5 had no compression. One patient (6%) experienced no immediate pain relief. Eight (47%) were pain free at the longest follow-up (mean 4.3 years, ranging 2 weeks to 13 years). One patient (6%) had their throat pain relapsed at 2 months. Pain free survival was 8 years and the time until therapy failure, defined as the time of pain return at equal or worse intensity from pre-operative level, was 10.4 years. Thirteen patients (77%) had short-term complaints: the most common being dysphagia, hoarseness, ipsilateral hearing loss, and loss of taste at two weeks. All recovered except three patients (18%) who had tolerable dizziness, loss of taste and jaw pain at longest follow up.

    Conclusions: Glossopharyngeal MVD with IX/X complex sectioning is a safe and effective surgical therapy for glossopharyngeal neuralgia with an initial pain freedom in 94% of patients and an excellent long-term pain relief of 10 years.

    Patient Care: This research has important implications for informed consent and patient education about pain free survival and quality of life after microvascular decompression and sectioning of the vagoglossopharyngeal complex.

    Learning Objectives: By the end of this session, participants should be able to describe glossopharyngeal neuralgia as a pain syndrome, identify common intraoperative findings, and discuss the long term quality of life benefits of microvascular decompression and sectioning of the vagoglossopharyngeal complex.

    References:

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