Neurosurgical Choice for Glossopharyngeal Neuralgia: A Benefit–Harm Assessment of Long-Term Quality of Life

Abstract BACKGROUND Microvascular decompression (MVD) and vagoglossopharyngeal rhizotomy (VGR) are effective treatment for glossopharyngeal neuralgia (GN). However, surgical choice is controversial due to the need to maximize pain relief and reduce complications. OBJECTIVE To retrospectively compare safety, efficacy, long-term quality of life (QOL), and global impression of change following MVD and VGR for treatment of GN. METHODS Patient database reviews and telephone surveys were conducted to assess baseline characteristics and long-term outcomes. The effects of pain and complications on QOL were assessed using Brief Pain Inventory-Facial (BPI-Facial) questionnaire. Complication tolerance and surgery satisfaction were sorted using the global impression of change survey. RESULTS Of 87 patients with GN, 63 underwent MVD alone, 20 underwent VGR alone, and 4 underwent VGR following a failed MVD. The long-term rate of pain relief was slightly, but not significantly, lower following MVD than VGR (83.6% vs 91.7%, P = .528). However, long-term complications occurred much more frequently following VGR (3.0% vs 50.0%, P < .001). The BPI-Facial, which evaluates pain and complications, showed that MVD had better postoperative QOL than VGR (P < .001). However, 91.7% of patients who underwent VGR experienced no or mild complications. There was no significant difference in the overall satisfaction rates between the groups (83.3% vs 83.6%, P > .99). CONCLUSION Although VGR resulted in lower postoperative QOL due to a high complication rate, most of these complications were mild. The overall satisfaction rates for the 2 surgeries were similar.

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Commentary: Neurosurgical Choice for Glossopharyngeal Neuralgia: A Benefit-Harm Assessment of Long-Term Quality of Life

Neurosurgery ◽

10.1093/neuros/nyaa327 ◽

2020 ◽

Vol 88 (1) ◽

pp. E35-E35

Author(s):

Raymond F Sekula

Keyword(s):

Quality Of Life ◽

Glossopharyngeal Neuralgia

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Pain-free survival after vagoglossopharyngeal complex sectioning with or without microvascular decompression in glossopharyngeal neuralgia

Journal of Neurosurgery ◽

10.3171/2018.8.jns18239 ◽

2020 ◽

Vol 132 (1) ◽

pp. 232-238 ◽

Cited By ~ 4

Author(s):

Zoe E. Teton ◽

Katherine G. Holste ◽

Fran A. Hardaway ◽

Kim J. Burchiel ◽

Ahmed M. Raslan

Keyword(s):

Quality Of Life ◽

Pain Relief ◽

Microvascular Decompression ◽

Glossopharyngeal Neuralgia ◽

Long Term Outcome ◽

Free Survival ◽

Throat Pain

OBJECTIVEGlossopharyngeal neuralgia (GN) is a rare pain condition in which patients experience paroxysmal, lancinating throat pain. Multiple surgical approaches have been used to treat this condition, including microvascular decompression (MVD), and sectioning of cranial nerve (CN) IX and the upper rootlets of CN X, or a combination of the two. The aim of this study was to examine the long-term quality of life and pain-free survival after MVD and sectioning of the CN X/IX complex.METHODSA combined retrospective chart review and a quality-of-life telephone survey were performed to collect demographic and long-term outcome data. Quality of life was assessed by means of a questionnaire based on a combination of the Barrow Neurological Institute pain intensity scoring criteria and the Brief Pain Inventory–Facial. Kaplan-Meier analysis was performed to determine pain-free survival.RESULTSOf 18 patients with GN, 17 underwent sectioning of the CN IX/X complex alone or sectioning and MVD depending on the presence of a compressing vessel. Eleven of 17 patients had compression of CN IX/X by the posterior inferior cerebellar artery, 1 had compression by a vertebral artery, and 5 had no compression. One patient (6%) experienced no immediate pain relief. Fifteen (88%) of 17 patients were pain free at the last follow-up (mean 9.33 years, range 5.16–13 years). One patient (6%) experienced throat pain relapse at 3 months. The median pain-free survival was 7.5 years ± 10.6 months. Nine of 18 patients were contacted by telephone. Of the 17 patients who underwent sectioning of the CN IX/X complex, 13 (77%) patients had short-term complaints: dysphagia (n = 4), hoarseness (n = 4), ipsilateral hearing loss (n = 4), ipsilateral taste loss (n = 2), and dizziness (n = 2) at 2 weeks. Nine patients had persistent side effects at latest follow-up. Eight of 9 telephone respondents reported that they would have the surgery over again.CONCLUSIONSSectioning of the CN IX/X complex with or without MVD of the glossopharyngeal nerve is a safe and effective surgical therapy for GN with initial pain freedom in 94% of patients and an excellent long-term pain relief (mean 7.5 years).

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130 Pain Free Survival After Microvascular Decompression and Sectioning of the Vagoglossopharyngeal Nerve Complex in Glossopharyngeal Neuralgia

Neurosurgery ◽

10.1093/neuros/nyx417.130 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 229-230

Author(s):

Katherine Holste ◽

Ahmed M T Raslan ◽

Kim J Burchiel

Keyword(s):

Quality Of Life ◽

Pain Relief ◽

Microvascular Decompression ◽

Glossopharyngeal Neuralgia ◽

Pain Intensity Score ◽

Free Survival ◽

Throat Pain

Abstract INTRODUCTION Glossopharyngeal neuralgia (GN) is a rare pain condition in which patients experience paroxysmal, lancinating throat pain. There are multiple surgical approaches to this disorder including microvascular decompression (MVD), sectioning of cranial nerves IX and the upper rootlets of X, or a combination of the two. The aim of this study was to examine the long term quality of life and pain free survival after both MVD and sectioning of the X/IX complex. METHODS A combined retrospective chart review and a quality of life telephone survey were performed to collect demographic information and long-term outcomes. Quality of life was assessed by a modified Barrow Neurological Institute Pain Intensity Score and a Brief Pain Inventory - Facial scale questionnaires. Kaplan-Meier analysis was done for pain free survival. RESULTS >Seventeen patients had an MVD and/or sectioning of the IX/X complex. Eleven patients had compression of IX/X by the Posterior Inferior Cerebellar Artery, 1 by a vertebral artery and 5 had no compression. One patient (6%) experienced no immediate pain relief. Eight (47%) were pain free at the longest follow-up (mean 4.3 years, ranging 2 weeks to 13 years). One patient (6%) had their throat pain relapsed at 2 months. Pain free survival was 8 years and the time until therapy failure, defined as the time of pain return at equal or worse intensity from pre-operative level, was 10.4 years. Thirteen patients (77%) had short-term complaints: the most common being dysphagia, hoarseness, ipsilateral hearing loss, and loss of taste at two weeks. All recovered except three patients (18%) who had tolerable dizziness, loss of taste and jaw pain at longest follow up. CONCLUSION Glossopharyngeal MVD with IX/X complex sectioning is a safe and effective surgical therapy for glossopharyngeal neuralgia with an initial pain freedom in 94% of patients and an excellent long-term pain relief of 10 years.

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Thinking Beyond Language: Intervention for Severe Aphasia

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld19.1.15 ◽

2009 ◽

Vol 19 (1) ◽

pp. 15-22 ◽

Cited By ~ 3

Author(s):

Nina Simmons-Mackie

Keyword(s):

Quality Of Life ◽

Communication Training ◽

Language Intervention ◽

Specific Training ◽

Environmental Support ◽

Total Communication ◽

Communication Partners

Abstract Purpose: This article addresses several intervention approaches that aim to improve life for individuals with severe aphasia. Because severe aphasia significantly compromises language, often for the long term, recommended approaches focus on additional domains that affect quality of life. Treatments are discussed that involve increasing participation in personally relevant life situations, enhancing environmental support for communication and participation, and improving communicative confidence. Methods: Interventions that have been suggested in the aphasia literature as particularly appropriate for people with severe aphasia include training in total communication, training of communication partners, and activity specific training. Conclusion: Several intervention approaches can be implemented to enhance life with severe aphasia.

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