Clinical efficacy of microvascular decompression of glossopharyngeal nerve combined with vagus nerve for patients with primary glossopharyngeal neuralgia

WANG Jing; JIANG Cheng-rong; CHONG Yu-long; LU Tian-yu; LIANG Wei-bang

doi:10.13798/j.issn.1009-153X.2024.01.004

Abstract：Objective To investigate the surgical techniques and efficacy of microvascular decompression(MVD)of glossopharyngeal nerve combined with vagus nerve for patients with primary glossopharyngeal neuralgia(GPN).Methods The clinical data of 50 patients with primary GPN treated by MVD from January 2013 to October 2021 were retrospectively analyzed.Cranial nerve 3D-TOF-MRA examination and tetracaine test were performed in all the patients before the surgery.Glossopharyngeal nerve and vagus nerve were decompressed,and rhizotomy was not performed in all the patients during the operation.Results According to preoperative MRI and intraoperative findings,except 1 patient(2%),the roots of glossopharyngeal nerve and/or vagus nerve were contact to or compressed by blood vessels in 49 patients,of which the vertebral arteries were responsilble vessels in 14 patients(28%),the posterior inferior cerebellar arteries and/or their branches in 28(56%),the anterior inferior cerebellar arteries in 6(12%),vein in 1(2%).Of 50 patients,47 patients(94%)were cured immediately,1 was significantly improved,and 2 were ineffective after the surgery.The postoperative follow-up ranged from 7 months to 105 months,with an average of(46.7±28.8)months and a median of 48.5 months.One patient with significant improvement immediately after the surgery had no significant change after 55 months of follow-up.One patient who was ineffective immediately after the surgery was cured one week after the surgery.One patient cured immediately after the surgery had pain again 2 months after the surgery,but the degree of pain was significantly improved compared with that before the surgery.One patient had a foreign body sensation in the pharynx after the surgery,which did not improve after 28 months of follow-up.One patient had transient dysphagia after the operation,and the symptoms disappeared 6 months after the operation.Conclusions Preoperative imaging and tetracaine test are very important for the diagnosis of primary GPN.Glossopharyngeal nerve combined with vagus nerve decompression is a safe and effective method for the treatment of primary GPN,and glossopharyngeal nerve and vagus nerve rhiotomy is not recommended.