Staged bilateral microsurgical rhizotomy for treatment of bilateral glossopharyngeal neuralgia: illustrative case.

Megan M J Bauman, Semirra L Bayan, Maria Peris Celda
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Abstract

Background: Glossopharyngeal neuralgia (GPN) is a rare disorder characterized by severe, episodic pain along the sensory distribution of cranial nerve (CN) IX. Bilateral GPN presents unique challenges for consideration of microsurgical treatment due to potential risks of postoperative dysphagia and cardiac arrhythmias associated with resection of bilateral CN IX/X. Here, the authors describe successful staged bilateral microsurgical rhizotomy of CN IX and upper CN X rootlets to treat bilateral GPN.

Observations: A 54-year-old female presented with right GPN and underwent a right retrosigmoid craniotomy with rhizotomy, resulting in complete resolution of pain. During the following year, the patient developed left GPN and was considered for the same surgical intervention. However, prior to pursuing surgical intervention, evaluation of her swallowing function was conducted to stratify her risk of pharyngeal sensory denervation or dysphagia, and to confirm her suitability for left-sided rhizotomy. Given the patient's normal oropharyngeal swallowing function on videofluoroscopic swallow study, she underwent left retrosigmoid craniotomy with rhizotomy. At the 3-month follow-up, the patient described complete resolution of pain and normal swallowing function.

Lessons: With the use of comprehensive patient evaluation between surgical stages, staged bilateral microsurgical rhizotomy is a feasible and safe treatment option for carefully selected patients with bilateral GPN. https://thejns.org/doi/10.3171/CASE25359.

分阶段双侧显微外科神经根切断术治疗双侧舌咽神经痛:说明性病例。
背景:舌咽神经痛(GPN)是一种罕见的疾病,其特征是沿颅神经(CN)感觉分布的严重,发作性疼痛。由于双侧CN IX/X切除术相关的术后吞咽困难和心律不整的潜在风险,双侧GPN对显微外科治疗提出了独特的挑战。在这里,作者描述了成功的分阶段双侧显微外科根切断术治疗双侧GPN的CN IX和CN X上根。观察:一名54岁女性患者出现右侧GPN,并行右侧乙状窦后颅骨切开术和根茎切开术,疼痛完全缓解。在接下来的一年中,患者出现左侧GPN,并考虑进行相同的手术干预。然而,在进行手术干预之前,我们对患者的吞咽功能进行了评估,以确定其咽部感觉神经丧失或吞咽困难的风险,并确认其是否适合左侧神经根切断术。考虑到患者吞咽检查显示口咽吞咽功能正常,她接受了左乙状窦后颅骨切开术和鼻根切开术。在3个月的随访中,患者描述疼痛完全消退,吞咽功能正常。经验教训:通过对患者在手术阶段之间的综合评估,对于精心挑选的双侧GPN患者,分阶段双侧显微外科神经根切断术是一种可行且安全的治疗选择。https://thejns.org/doi/10.3171/CASE25359。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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