Repeat Gamma-Knife Radiosurgery for Recurrent Glossopharyngeal Neuralgia: Case Report and Literature Review

Abstract BACKGROUND AND IMPORTANCE Hemi-laryngopharyngeal spasm (HeLPS) has been recently described but is not yet widely recognized. Patients describe intermittent coughing and choking and can be cured following microvascular decompression of their Xth cranial nerve. This case report and literature review highlight that HeLPS can co-occur with glossopharyngeal neuralgia (GN) and has been previously described (but not recognized) in the neurosurgical literature. CLINICAL PRESENTATION A patient with GN and additional symptoms compatible with HeLPS is presented. The patient reported left-sided, intermittent, swallow-induced, severe electrical pain radiating from her ear to her throat (GN). She also reported intermittent severe coughing, throat contractions causing a sense of suffocation, and dysphonia (HeLPS). All her symptoms resolved following a left microvascular decompression of a loop of the posterior inferior cerebellar artery that was pulsating against both the IXth and Xth cranial nerves. A review of the senior author's database revealed another patient with this combination of symptoms. An international literature review found 27 patients have been previously described with symptoms of GN and the additional (but not recognized at the time) symptoms of HeLPS. CONCLUSION This review highlights that patients with symptoms compatible with HeLPS have been reported since 1926 in at least 4 languages. This additional evidence supports the growing recognition that HeLPS is another neurovascular compression syndrome. Patients with HeLPS continue to be misdiagnosed as conversion disorder. The increased recognition of this new medical condition will require neurosurgical treatment and should alleviate the suffering of these patients.

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Case Report: Dacomitinib Overcomes Osimertinib Resistance in NSCLC Patient Harboring L718Q Mutation: A Case Report

Frontiers in Oncology ◽

10.3389/fonc.2021.760097 ◽

2021 ◽

Vol 11 ◽

Author(s):

Qian Shen ◽

Jingjing Qu ◽

Zhen Chen ◽

Jianying Zhou

Keyword(s):

Case Report ◽

Disease Progression ◽

Gamma Knife ◽

Parietal Lobe ◽

Brain Mri ◽

Gamma Knife Radiosurgery ◽

Small Cell ◽

Egfr Mutations ◽

Small Subset ◽

Small Cell Lung

BackgroundAdvanced non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations has been successfully treated with tyrosine kinase inhibitors (TKIs). However, resistance to osimertinib, a third-generation TKI, can be difficult to overcome in this small subset of patients and is attributed to secondary resistant mutations. Here, we report a case of acquired EGFR L858R/L718Q mutation with advanced NSCLC that resistant to osimertinib, which was successfully overcome using dacomitinib.Case PresentationA 64-year-old non-smoker woman was diagnosed with stage IV non-small cell lung adenocarcinoma with EGFR L858R mutation and brain metastasis in November 2018. Treatment with gefitinib and gamma knife radiosurgery was started as the first-line treatment. After 7 months, she experienced disease progression with increased primary lung lesions and switched to osimertinib based on an acquired EGFR T790M mutation. After another 4 months, the disease progressed, and she was switched to chemotherapy. During chemotherapy, brain MRI showed an increasing number of parietal lobe metastases. Hence, gamma knife radiosurgery was performed again. After 12 months, the disease progression resumed, and an EGFR L718Q mutation was found on biopsy. The patient was then challenged with dacomitinib, and the disease was partially responsive and under control for 6 months.ConclusionCurrently, there are no established guidelines for overcoming osimertinib resistance caused by the L718Q mutation. The acquired EGFR L718Q mutation in subsequent resistance to osimertinib could be overcome using dacomitinib, indicating a promising treatment option in the clinic.

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Paradoxical worsening with superior ophthalmic vein thrombosis after gamma knife radiosurgery for dural arteriovenous fistula of cavernous sinus: a case report suggesting the mechanism of the phenomenon

Eye ◽

10.1038/sj.eye.6702287 ◽

2006 ◽

Vol 20 (12) ◽

pp. 1426-1428 ◽

Cited By ~ 13

Author(s):

L-I Lau ◽

H-M Wu ◽

A-G Wang ◽

M-Y Yen ◽

W-M Hsu

Keyword(s):

Case Report ◽

Arteriovenous Fistula ◽

Gamma Knife ◽

Cavernous Sinus ◽

Dural Arteriovenous Fistula ◽

Gamma Knife Radiosurgery ◽

Superior Ophthalmic Vein ◽

Vein Thrombosis ◽

Paradoxical Worsening

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Combined treatment of a medulla oblongata hemangioblastoma via permanent cysto-cisternal drainage and (postponed) gamma knife radiosurgery: a case report and review of the literature

International Journal of Neuroscience ◽

10.1080/00207454.2020.1819267 ◽

2020 ◽

pp. 1-5

Author(s):

Robert Bartoš ◽

Jan Lodin ◽

Tomas Marek ◽

Martin Sameš ◽

Veronika Němcová ◽

...

Keyword(s):

Case Report ◽

Gamma Knife ◽

Medulla Oblongata ◽

Combined Treatment ◽

Gamma Knife Radiosurgery ◽

Review Of The Literature ◽

Cisternal Drainage

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Gamma Knife radiosurgery for glossopharyngeal neuralgia: A study of 21 patients with long-term follow-up

Cephalalgia ◽

10.1177/0333102417698961 ◽

2017 ◽

Vol 38 (3) ◽

pp. 543-550 ◽

Cited By ~ 5

Author(s):

Pierre-Yves Borius ◽

Constantin Tuleasca ◽

Xavier Muraciole ◽

Laura Negretti ◽

Luis Schiappacasse ◽

...

Keyword(s):

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Rare Condition ◽

Glossopharyngeal Neuralgia ◽

University Hospitals ◽

Minimally Invasive Surgical ◽

Long Term Follow Up ◽

The Mean

Objective Glossopharyngeal neuralgia (GPN) is a very rare condition, affecting the patient’s quality of life. We report our experience in drug-resistant, idiopathic GPN, treated with Gamma Knife radiosurgery (GKRS), in terms of safety and efficiency, on a very long-term basis. Methods The study was opened, self-controlled, non-comparative and bicentric (Marseille and Lausanne University Hospitals). Patients treated with GKRS between 2003 and 2015 (models C, 4C and Perfexion) were included. A single 4-mm isocentre was positioned in the cisternal portion of the glossopharyngeal nerve, with a targeting based both on magnetic resonance imaging (MRI) and computed tomography (CT). The mean maximal dose delivered was 81.4 ± 6.7 Gy (median = 85 Gy, range = 60–90 Gy at the 100% isodose line). Results Twenty-one patients (11 women, 10 men) benefited from 25 procedures. The mean follow-up period was 5.2 ± 3 years (range = 0.9–12.1 years). Seventeen (81%) were initially pain-free after GKRS. At three months, six months and one year after radiosurgery, the percentage of patients with good outcome (BNI classes I to IIIA) was 87.6%, 100% and 81.8%, respectively. Ten cases (58.8%) from the initial pain-free ones had a recurrence, after a mean period of 13.6 ± 10.4 months (range = 3.1–36.6 months). Only three patients (14.2%) had recurrences (two for each one of them) requiring further surgeries. Three patients underwent a second GKRS procedure; one case needed a third GKRS. The former procedures were performed at 7, 17, 19 and 30 months after the first one, respectively. Furthermore, two patients needed additional interventions. At last follow-up, 17 cases (80.9%) were still pain-free without medication. The actuarial pain relief without new surgery was 83%. A transient complication (paraesthesia of the edge of the tongue) was seen in one case (4.8%). Conclusion GKRS is a valuable, minimally invasive, surgical alternative for idiopathic GPN, with a very high short- and long-term efficacy and without permanent complications. A quality imaging, including T2 CISS/Fiesta MRI and bone CT acquisitions for good visualisation of the nerve and the other bony anatomic landmarks, is essential for targeting accuracy and successful therapy.

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