Skip to main content
SpringerLink
Log in

Reoperation after failed microvascular decompression for glossopharyngeal neuralgia

  • Original Article - Functional Neurosurgery - Pain
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Microvascular decompression (MVD) is known as a safe and effective procedure to treat glossopharyngeal neuralgia (GN). However, some patients experienced poor pain relief after MVD, for which the mechanism is not clear yet. Reviewing the intraoperative findings and postoperative effect of reoperation for patients who failed the first MVD, is helpful to figure out why the first MVD for GN failed.

Methods

There were eight patients with GN who failed first MVD. The possibilities for secondary GN were eliminated by physical and radiological examination. The reoperation through the previous incision was conducted, and appropriately, treatment was provided according to the intraoperative findings. The video data and prognosis of the reoperation were retrospectively reviewed. The reasons for the invalid first MVD were analyzed.

Results

To the end of follow-up, there were 7 patients of pain-free, and one patient with occasional mild pain attacks (VAS 2). There was one patient who experienced transient hoarseness in 3 months after the reoperation. We summarized the causes for failed first MVD which were omission of the offending vessel in 3 cases, inadequate decompression of the nerve root in 2 cases, and excessive decompression materials which caused iatrogenic nerve root compression in 3 cases.

Conclusions

For patients with recurrent or failed after MVD, a thorough examination should be carried out to eliminate the possibility of secondary GN. Reoperation through the previous incision is safe and effective. The bone window should be close enough to the sigmoid sinus to aid the exposure of the nerve root. The nerve transection could be adopted if no offending vessels were found. And a multi-site decompression could be used when the vertebral artery is the offending vessel.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Bartek J, Gulati S, Unsgåd G et al (2016) Standardized reporting of adverse events after microvascular decompression of cranial nerves; a population-based single-institution consecutive series. Acta Neurochir 158:1775–1781

    Article  Google Scholar 

  2. Bernard F, Mercier P, Sindou M (2018) The tethered effect of the arachnoid in vago-glossopharyngeal neuralgia: a real associated alternative mechanism. Acta Neurochir 160:151–155

    Article  Google Scholar 

  3. Bharti N, Chattopadhyay S, Singla N et al (2018) Pulsed radiofrequency ablation for the treatment of glossopharyngeal neuralgia secondary to oropharyngeal carcinoma. Pain Physician 21:295–302

    Article  Google Scholar 

  4. Borius PY, Tuleasca C, Muraciole X et al (2018) Gamma knife radiosurgery for glossopharyngeal neuralgia: a study of 21 patients with long-term follow-up. Cephalalgia 38:543–550

    Article  Google Scholar 

  5. Chen J, Sindou M. (2015) Vago-glossopharyngeal neuralgia: a literature review of neurosurgical experience. Acta Neurochir 157:311–321; discussion 321

  6. Donahue J H, Ornan D A, (2017) Mukherjee S. Imaging of vascular compression syndromes. Radiol Clin N Am 55(1):123

  7. Franzini A, Messina G, Franzini A et al (2017) Treatments of glossopharyngeal neuralgia: towards standard procedures. Neurol Sci 38:51–55

    Article  Google Scholar 

  8. Franzini A, Moosa S, D'Ammando A et al (2019) The neurosurgical treatment of craniofacial pain syndromes: current surgical indications and techniques. Neurol Sci 40:159–168

    Article  Google Scholar 

  9. Haller S, Etienne L, Kövari E et al (2016) Imaging of neurovascular compression syndromes: trigeminal neuralgia, Hemifacial spasm, vestibular paroxysmia, and glossopharyngeal neuralgia. AJNR Am J Neuroradiol 37:1384–1392

    Article  CAS  Google Scholar 

  10. Homeida L, Elmuradi S, Sollecito TP et al (2016) Synchronous presentation of trigeminal, glossopharyngeal and geniculate neuralgias in a single patient. Oral Surg Oral Med Oral Pathol Oral Radiol 121:626–628

    Article  Google Scholar 

  11. Kano H, Urgosik D, Liscak R et al (2016) Stereotactic radiosurgery for idiopathic glossopharyngeal neuralgia: an international multicenter study. J Neurosurg 125:147–153

    Article  Google Scholar 

  12. Kent DT, Rath TJ, Snyderman C (2015) Conventional and 3-dimensional computerized tomography in Eagle’s syndrome, glossopharyngeal neuralgia, and asymptomatic controls. Otolaryngol Head Neck Surg 153:41–47

    Article  Google Scholar 

  13. Kim MK, Park JS, Ahn YH (2017) Microvascular decompression for glossopharyngeal neuralgia: clinical analyses of 30 cases. J Korean Neurosurg Soc 60:738–748

    Article  Google Scholar 

  14. Lu VM, Goyal A, Graffeo CS et al (2018) Glossopharyngeal neuralgia treatment outcomes after nerve section, microvascular decompression, or stereotactic radiosurgery: a systematic review and meta-analysis. World Neurosurg 120:572–82.e7

    Article  Google Scholar 

  15. Ma Y, Li YF, Wang QC et al (2016) Neurosurgical treatment of glossopharyngeal neuralgia: analysis of 103 cases. J Neurosurg 124:1088–1092

    Article  Google Scholar 

  16. Ordonez-Rubiano EG, Garcia-Chingate CC, Rodriguez-Vargas S et al (2017) Microvascular decompression for a patient with a glossopharyngeal neuralgia: a technical note. Cureus 9:e1494

    PubMed  PubMed Central  Google Scholar 

  17. Palanisamy D, Kyosuke M, Yasuhiro Y et al (2018) Management of recurrent glossopharyngeal neuralgia following microvascular decompression surgery. World Neurosurg 117:339–343

    Article  Google Scholar 

  18. Saccomanno S, Greco F, DE CE, et al. (2018) Eagle’s syndrome, from clinical presentation to diagnosis and surgical treatment: a case report. Acta Otorhinolaryngol Ital 38:166–169

  19. Tanrikulu L, Scholz T, Nikoubashman O et al (2015) Preoperative MRI in neurovascular compression syndromes and its role for microsurgical considerations. Clin Neurol Neurosurg 129:17–20

    Article  Google Scholar 

  20. Truini A, Colonnese C, Manfredi M (2015) Glossopharyngeal nerve contrast enhancement in recent-onset glossopharyngeal neuralgia. Neurology 84:1283

    Article  Google Scholar 

  21. Wang J, Yu R, Qu C et al (2018) Does glossopharyngeal neuralgia need rhizotomy in neurovascular decompression surgery. J Craniofac Surg 29:2192–2194

    Article  Google Scholar 

  22. Xia L, Li YS, Liu MX et al (2018) Microvascular decompression for glossopharyngeal neuralgia: a retrospective analysis of 228 cases. Acta Neurochir 160:117–123

    Article  Google Scholar 

  23. Zhu Q, Wang S, Chen R et al (2018) Continuous radiofrequency thermocoagulation under CT-guidance for glossopharyngeal neuralgia: two case reports. Medicine (Baltimore) 97:e11079

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, People’s Republic of China

    Bing Ni, Yongsheng Hu, Tao Du, Xiaohua Zhang & Hongwei Zhu

Authors
  1. Bing Ni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yongsheng Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tao Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiaohua Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hongwei Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hongwei Zhu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of retrospective study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Functional Neurosurgery - Pain

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ni, B., Hu, Y., Du, T. et al. Reoperation after failed microvascular decompression for glossopharyngeal neuralgia. Acta Neurochir 162, 2783–2789 (2020). https://doi.org/10.1007/s00701-020-04383-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-020-04383-w

Keywords

Search

Navigation