Glossopharyngeal neuralgia with cardiac syncope treated by glossopharyngeal rhizotomy and microvascular decompression

Abstract A glossopharyngeal neuralgia case with cardiac asystole is presented. The sinus mode dysfunction and subsequent syncope with pain appears to be the most important life-threatening symptom in the late period of the disease. Because of cardiac symptoms induced by intense vagal stimulation, this case was considered to be vagoglossopharyngeal neuralgia. Several medical and surgical alternatives have been proposed for its treatment. In the presented case the cause of disease was compression of lower cranial nerves in the right cerebello-pontine angle (CPA) by the vertebro-basilar arterial system. Carbamazepine and pacing were determined ineffective, so the patient was treated surgically by cutting the glossopharyngeal nerve and by decompression of the vagal nerve at the CPA. The sinus arrest and paroxysmal pain attacks disappeared and the patient's life returned to normal.

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Disease of lower cranial nerves caused by vascular compression

Acta chirurgica iugoslavica ◽

10.2298/aci0802027a ◽

2008 ◽

Vol 55 (2) ◽

pp. 27-31 ◽

Cited By ~ 1

Author(s):

B.D. Antic ◽

P. Peric ◽

S.Lj. Stefanovic

Keyword(s):

Surgical Treatment ◽

Cranial Nerves ◽

Postoperative Outcome ◽

Glossopharyngeal Neuralgia ◽

Statistic Analysis ◽

Vascular Compression ◽

Excellent Outcome ◽

Surgical Options ◽

Lower Cranial Nerves ◽

Surgical Option

Between April 1989 and September 2007, 181 patients with disease of lower cranial nerves (DLCN) underwent posterior fossa exploration. As a cause of DLCN, vascular compression (VC) was present in 89 patients with trigeminal neuralgia (TN), in 6 with hemifacial spasm (HFS), in 1 with glossopharyngeal neuralgia, in 1 with Meniere?s disease, and in 5 with multiple DLCN. Depending on intraoperative findings, different surgical options were used: microvascular decompression (MVD), MVD with partial sensory rhizotomy (PSR) or total sensory rhizotomy (TSR). Statistic analysis was made using the Fisher?s exact 2-side test. In patients with TN, excellent outcome was archived in 83 patients and good in 6. Postoperative outcome was better (p = 0.007) in cases with severe VC, but without significant correlation between used surgical option and outcome (p = 0.402). Frequency rate of relapses did not depend on severity of VC (p = 0.502) and used surgical option (p = 0.175). In 6 patients with HFS, excellent outcome was archived in 5 with arterial compression and poor in 1 with venous contact. In patients with Meniere?s disease and glossopharyngeal neuralgia, MVD result with excellent outcome. In 5 patients with multiple DLCN, excellent outcome was archived in 3 and good in 2. MVD is method of choice in surgical treatment of DLCN caused by VC. Overall outcome is better with severity of VC.

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Gamma Knife surgery for glossopharyngeal neuralgia

Journal of Neurosurgery ◽

10.3171/2008.8.17641 ◽

2009 ◽

Vol 110 (3) ◽

pp. 559-563 ◽

Cited By ~ 26

Author(s):

Shoji Yomo ◽

Yasser Arkha ◽

Anne Donnet ◽

Jean Régis

Keyword(s):

Pain Relief ◽

Gamma Knife ◽

Cranial Nerves ◽

Initial Response ◽

Neurological Complications ◽

Gamma Knife Surgery ◽

Glossopharyngeal Neuralgia ◽

Invasive Treatment ◽

Neurological Effects ◽

Lower Cranial Nerves

Gamma Knife surgery (GKS) is widely recognized as an effective, minimally invasive treatment for intractable trigeminal neuralgia, but the role of GKS in glossopharyngeal neuralgia (GPN) remains unclear. This study involved 2 patients with medically intractable GPN who were treated using GKS. One patient required 2 treatments because of a recurrence of symptoms (at maximum doses of 60 and 70 Gy), and the other patient had a single intervention (at a maximum dose of 75 Gy). The GKS target was the distal part of the glossopharyngeal nerve. Patients were investigated prospectively, treated, and then assessed periodically with respect to pain relief and neurological function. Complete pain relief was achieved initially after all 3 interventions. The first patient was pain free without medication for 2 months after the first treatment (60 Gy) and for 4 months after the second treatment (70 Gy). The second patient (treated with 75 Gy) was still pain free without medication at the last follow-up (12 months). Neither patient had any neurological complications. The initial response of GPN to low-dose GKS was favorable, but symptoms may recur. No adverse neurological effects were observed in any of the lower cranial nerves. It will be necessary to investigate the optimal radiation dose and target of GKS for achieving long-term pain relief in GPN.

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Extended Anterolateral Infralabyrinthine Transjugular Approach for Microsurgical Resection of Giant Glomus Vagale Tumor: Operative Video and Technical Nuances

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1716532 ◽

2020 ◽

Author(s):

James K. Liu ◽

Kevin Zhao ◽

Soly Baredes ◽

Robert W. Jyung

Keyword(s):

Skull Base ◽

Cranial Nerves ◽

Jugular Foramen ◽

Neck Mass ◽

Preoperative Embolization ◽

Rare Type ◽

Lower Cranial Nerve ◽

Microsurgical Resection ◽

The Right ◽

Lower Cranial Nerves

AbstractGlomus vagale tumor is a paraganglioma of the vagus nerve. It is a rare type of benign tumor that occupies the head and neck and skull base regions. Patients often present with lower cranial nerve dysfunctions such as difficulty swallowing, tongue weakness, and hoarseness. Surgical treatment can be complex and difficult due to its high vascularity, frequent involvement of lower cranial nerves, and surrounding critical vascular structures. In this operative video, we demonstrate an extended anterolateral infralabyrinthine transjugular approach for microsurgical resection of a giant glomus vagale tumor in a 53-year-old male who presented with an enlarging neck mass, difficulty swallowing, right tongue weakness, and hoarseness. Imaging revealed a giant glomus vagale tumor in the right parapharyngeal space extending into the jugular foramen with occlusion of the internal jugular vein. After preoperative embolization, the patient underwent a near-total resection of the tumor with a small microscopic residual at the pars nervosa. In summary, the extended anterolateral infralabyrinthine transjugular approach is a useful strategy for removal of giant glomus vagale tumors extending into the skull base. The surgical technique and nuances are described in a step-by-step fashion in this illustrative operative video.The link to the video can be found at: https://youtu.be/L0EosQK95LE.

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Endovascular Treatment of Aneurysms Using Flow-Diversion Embolization: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa462 ◽

2021 ◽

Author(s):

Daniel D Cavalcanti ◽

Peter Kim Nelson ◽

Eytan Raz ◽

Maksim Shapiro ◽

Erez Nossek ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Cranial Nerves ◽

Giant Aneurysm ◽

Flow Diverter ◽

Flow Diversion ◽

Neck Infection ◽

The Right ◽

Lower Cranial Nerves

Abstract Initially developed for large and giant wide-necked aneurysms of the internal carotid artery, flow diverter devices are now used in almost every location safely and with effectiveness.1-5 This video demonstrates a unique case of a giant aneurysm of the right petrous internal carotid artery in a 20-yr-old patient. This is an extremely rare location, and most of patients are asymptomatic.3-6 Signs of compression of the seventh and eight cranial nerves can be present and even Horner syndrome and lower cranial nerves neuropathies. Nevertheless, rupture can lead to epistaxis and otorrhagia, and ultimately to hemorrhagic shock. The patient in the current report was otherwise healthy but presented with lightheadedness and dizziness for 10 d. The patient consented to the procedure. There was no history of major trauma or head and neck infection. A transradial endovascular flow diversion embolization of a giant aneurysm of the petrous internal carotid artery is herein demonstrated in a stepwise manner. A triaxial system was used to deploy 3 overlapping devices. Concepts of J-wire technique, multiple coverage,1 and the so-called weld technique are emphasized. The role of adjunctive coiling and main reasons for failure are also discussed.7,8 Brief cases of flow diversion embolization of aneurysms of different morphologies at different locations are used to highlight the importance of assessing vessel wall apposition and follow-up imaging.

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Suboccipital Lateral Approach for Resection of Cerebellopontine Angle Meningioma: Operative Video and Technical Nuances

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1669982 ◽

2018 ◽

Vol 79 (S 05) ◽

pp. S397-S398

Author(s):

Mateus Reghin Neto ◽

Heros Melo Almeida ◽

João Almeida ◽

Ygor Alexim ◽

Matheus de Almeida ◽

...

Keyword(s):

Treatment Options ◽

Cranial Nerves ◽

Lateral Approach ◽

Magnetic Resonance Imaging Scan ◽

Extensive Resection ◽

Tumor Margins ◽

Postoperative Mri ◽

History Of ◽

The Right ◽

Lower Cranial Nerves

We present the case of a 34-year-old woman, who presented to our department with a 4 months history of dizziness, hearing loss, and tinnitus on the right side. MRI (magnetic resonance imaging) scan demonstrated a large extra-axial lesion, suggestive of a meningioma, with dural attachments to the petrosal bone surface and tentorium, closely related with the trigeminal, abducens, facial, vestibulocochlear, and lower cranial nerves in the right side. Treatment options were discussed with the patient, and surgical resection was selected to remove the lesion, and decompress the cranial nerves and brainstem. The surgery was performed with a patient in a semi-seated position with head placed in a flexed, nonrotated position. A right lateral suboccipital approach was performed, exposing the right transverse and sigmoid sinuses. After dura opening, microsurgical dissection was used to open the cisterna magna, and obtain cerebellum relaxation. That was followed by identification of cranial nerves VII–XII and then identification of the tumor itself. Tumor debulking was then performed with use of suction and ultrasonic aspirator. After extensive resection, the tumor margins were dissected away from brainstem, cerebellum, and cranial nerves. Finally, the tumor attachment to the tentorium was coagulated and cut and the tumor was completely removed. Postoperative MRI confirmed complete resection of the tumor. The patient was discharged on the 1st week after surgery, with no additional postoperative deficits or complications.The link to the video can be found at: https://youtu.be/aZ3jhZTAeAA.

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Chiari Type I Malformation Presenting as Glossopharyngeal Neuralgia: Case Report

Neurosurgery ◽

10.1097/00006123-200101000-00044 ◽

2001 ◽

Vol 48 (1) ◽

pp. 226-228 ◽

Cited By ~ 2

Author(s):

Yucel Kanpolat ◽

Agahan Unlu ◽

Ali Savas ◽

Funda Tan

Keyword(s):

Clinical Presentation ◽

Cranial Nerves ◽

Glossopharyngeal Neuralgia ◽

Cerebellar Tonsil ◽

Pathological State ◽

Type I ◽

Chiari Type ◽

Chiari Type I Malformation ◽

Lower Cranial Nerves ◽

Chiari Type I

Abstract OBJECTIVE AND IMPORTANCE Chiari Type I malformation is an important pathological state in which the brainstem is compressed by the cerebellar tonsil. We present a case of glossopharyngeal neuralgia caused by Chiari Type I malformation. CLINICAL PRESENTATION A 50-year-old male patient was admitted with glossopharyngeal neuralgia. Magnetic resonance imaging studies revealed caudal displacement of the left cerebellar tonsil. INTERVENTION Small occipital craniectomy and C1 laminectomy were performed. The left cerebellar tonsil was resected. CONCLUSION This glossopharyngeal neuralgia was caused by compression of the lower cranial nerves and brainstem by the displaced left cerebellar tonsil. Decompression and pain relief were obtained with resection of the cerebellar tonsil. The patient was pain-free 30 weeks after the operation.

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Midline Suboccipital Subtonsillar Approach with C1 Laminectomy for Resection of Foramen Magnum Meningioma: 2-Dimensional Operative Video

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1698823 ◽

2019 ◽

Vol 80 (S 04) ◽

pp. S365-S367

Author(s):

Stefan Lieber ◽

Maximiliano Nunez ◽

Rocio Evangelista-Zamora ◽

Marcos Tatagiba

Keyword(s):

Cranial Nerves ◽

Inpatient Rehabilitation ◽

Craniocervical Junction ◽

Foramen Magnum ◽

Proliferation Index ◽

Surgical Approaches ◽

Who Grade ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Lower Cranial Nerves

AbstractWe present a case of a medium-sized foramen magnum meningioma that was resected through a midline suboccipital subtonsillar approach with C1 laminectomy in prone (Concorde) position. The patient is a 77-year-old woman with a 6-month history of intermittent vertigo, moderate gait instability, and slight decline of memory.On magnetic resonance imaging (MRI) an extra-axial intradural lesion was discovered that originated from the right epicondylar region just inferior to the jugular tubercle and occupied the anterolateral aspect of the foramen magnum. There was moderate transposition and compression of the medulla at the level of the cerebellar tonsils.On physical examination the patient was ambulatory independently without motor weakness but exhibited some gait instability. The function of the lower cranial nerves was preserved.A gross-total resection was achieved, histopathology confirmed a WHO grade-I meningothelial meningioma with a low-proliferation index. The patient was discharged home 5 days after surgery, her gait instability improved significantly immediately after surgery and had resolved completely after 2 weeks of inpatient rehabilitation. There was no other neurological deficit. At 3-month follow-up MRI, there was no indication of meningioma residual or recurrence.In summary, the midline suboccipital subtonsillar approach is a powerful tool with limited morbidity in the armamentarium for the microsurgical management of a variety of pathologies residing in the posterior cranial fossa and the craniocervical junction. Oftentimes the space created by the pathology opens up corridors that can be exploited for microsurgical access to avoid more extensive surgical approaches.The link to the video can be found at: https://youtu.be/0uUxs13ze7w.

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Extra-axial cerebellopontine angle cavernoma: A case report and review of literature

Surgical Neurology International ◽

10.25259/sni_664_2020 ◽

2020 ◽

Vol 11 ◽

pp. 386

Author(s):

Bashar Abuzayed ◽

Anas Said ◽

Osama Jamous ◽

Omar Al-Ashqar ◽

Hussein Al-Abadi ◽

...

Keyword(s):

Cerebellopontine Angle ◽

Histopathological Examination ◽

Cranial Nerves ◽

Downbeat Nystagmus ◽

Hemosiderin Deposition ◽

Intraoperative Management ◽

Level Of Consciousness ◽

Axial Mass ◽

The Right ◽

Lower Cranial Nerves

Background: Extra-axial cavernomas at the cerebellopontine angle (CPA) are rare clinical entity that can radiologically mimic several lesions encountered at this location. Case Description: A 36-year-old female patient referred to our emergency service with acute decreased level of consciousness and vomiting. Neurological examination showed Glasgow Coma Scale of 12 with downbeat nystagmus of the right eye. Brain computed tomography scan and magnetic resonance imaging showed multilobulated extra-axial mass lesion located in the right CPA. The lesion was with various signal intensities in T1- and T2-weighted images suggestive of hemorrhages of different ages. T2 gradient echo sequences showed multiple sinusoid-like channels and diffuse hemosiderin deposition. These figures were compatible with cavernous malformation. The patient was operated by retrosigmoid approach. Dissection of the mass from the trigeminal, facial, vestibulocochlear, and lower cranial nerves was performed and total resection of the tumor was achieved. Histopathological examination confirmed the diagnosis of cavernoma. Conclusion: Although CPA cavernomas are very rare, they should be considered for differential diagnosis when evaluating CPA lesions preoperatively for better intraoperative management and postoperative outcomes.

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