Follow-up results of using microvascular decompression for treatment of glossopharyngeal neuralgia.

Abstract

Glossopharyngeal neuralgia (GPN) is an uncommon disorder that is characterized by a severe lancinating pain commonly induced by swallowing. There has been some debate among various authors as to which surgical procedure should be adopted to treat cases of GPN: microvascular decompression (MVD) or partial rhizotomy. The latter necessitates the partial destruction of normal neural structures. The purpose of this paper is to present follow-up results in patients with GPN who underwent MVD. Between 1980 and 1995, 20 patients underwent MVD for GPN. Results were studied to verify the effectiveness of MVD performed in 16 patients before 1991 who participated in follow-up evaluation for more than 5 years postoperatively. The follow-up period ranged from 5 to 16 years (mean +/- standard deviation 11.6 +/- 2.8 years). The method adopted for MVD was to reposition the offending vessel, such as a troublesome vertebral artery or posterior inferior cerebellar artery that is commonly ectatic and arteriosclerotic, by lifting the loop of the artery and using glue to affix it to the nearby dura mater of the petrous bone. Pain was relieved in all cases. Two patients complained of persistent mild hoarseness, causing the inability to speak loudly, and two patients complained of occasional coughing episodes that occurred for a couple of years after the surgery. No other complications were reported and no recurrence of pain was noted during the follow-up period. This procedure provided satisfactory results by preserving important perforating arteries in this area and by repositioning offending arteries in a safer and surer fashion, thus reducing complications and recurrence of GPN.