Gamma Knife Radiosurgery For Glossopharyngeal Neuralgia: Report Of 7 Cases

Leveque Marc1, Adyl Melhaoui1, Michael C. Park1, Shoji Yomo, MD2, Anne Donnet1, Jean Regis3

1Timone University Hospital, Marseille, France 2Saitama Gamma Knife Center, San-ai Hospital 3

Keywords: gamma knife, pain, glossopharyngeal neuralgia, outcome, cranial nerve

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     Although Gamma Knife radiosurgery (GKR) is widely recognized as an effective and minimally invasive treatment for intractable trigeminal neuralgia, its role in glossopharyngeal neuralgia (GPN) has not yet been determined.
     Between January 2002 and February 2009, 7 patients with medically intractable GPN were treated using GKR.  Indication for GKR was the presence of medically intractable GPN and patient’s refusal or contraindication to microvascular decompression.  Seven patients (5 male, 2 female, mean age 64, range 49-83) presented with symptoms for an average of 28 months (8-72). Four patients had a vasculo-nervous conflict.
     Patients underwent preoperative investigation and were evaluated postoperatively with periodic assessment of pain relief and neurological function.
      Patients were treated with a dose ranging from 60 to 80 Gy, targeted on the cisternal segment (n=2) or GlossoPharyngeal Meatus (GPM) (n=5). Outcome was favorable with cure of GPN in 5 of 7 patients (71%) in the short-term (3 months) and 4 of 7 (57%) patients in the long term (16 months).  One patient required 2 treatments because of a recurrence of symptoms and was treated with maximum doses of 60 and 70 Gy, respectively. There were no neurological complications.
     This is a retrospective study.
     All patients with GPM as a target that received a dose greater than 75 Gy were cured at long-term follow-up. The 2 patients with cisternal segment as the target and received a dose significantly lower than 70 Gy were not cured of their GPN. 
     There were no neurological deficits involving the lower cranial nerves. It will be necessary to investigate the optimal radiation dose and target of GKR for GPN in order to achieve long-term pain relief.


Project Roles:

L. Marc (), A. Melhaoui (), M. Park (), S. Yomo (), A. Donnet (), J. Regis ()