Analysis of clinical characteristics and therapeutic efficacy of 61 cases of primary drug-refractory glossopharyngeal neuralgia
Objective To analyze the clinical characteristics of patients with primary drug-refractory glossopharyngeal neuralgia(GPN)and the efficacy of different surgical methods.Methods A total of 61 patients with drug-refractory GPN diagnosed and treated at the Neurosurgery Department of Tianjin Huanhu Hospital from March 2014 to March 2021 were included for retrospective analysis.The male/female ratio was 32/29;the age was(67.7±25.4)years old(43-88 years old);the median disease duration was 44.1 months(7 days to 18 years).Microvascular decompression(MVD)was performed in 39 cases;rhizotomy(RHZ)was performed in 22 cases to cut off the glossopharyngeal nerve and the first branch of the vagus nerve.We documented the offending blood vessels of GPN,surgical efficacy and related complications.Results Among the 61 patients,most patients(63.9％,n=39)had the posterior inferior cerebellar artery(PICA)as the offending blood vessel identified during surgery,and 2 patients(3.3％)had no vascular compression.The pain of both groups of patients disappeared immediately after surgery,and the effective rate was 100％.After surgery,2 patients in the MVD group developed cerebral hemorrhage,1 died,and 1 remained with symptoms of mild neurological deficit.Eight cases(36.4％)in the RHZ group had dysfunction related to cranial nerves IX,X and XI,of which 5 cases were uvula deviation and 3 cases were coughing during swallowing;1 patient in MVD group(2.7％)had coughing during swallowing;the difference between the two groups was statistically significant(P=0.001).All 61 patients were followed up for(56.7± 38.5)months(12 to 96 months)after surgery,and 1 patient(2.7％)in the MVD group had recurrence of pain 46 months after surgery.The 5 patients with uvula deviation all improved 6 months after surgery;among the 4 patients with choking and coughing when swallowing,only 1 patient in the RHZ group occasionally had symptoms of choking and coughing.Conclusions MVD is an effective surgical procedure for the treatment of primary GPH.RHZ is an effective complementary procedure to MVD.Although the incidence of complications is high,most of them can be recovered without serious complications.
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