Microvascular decompression for a unique case of glossopharyngeal neuralgia with provokable symptomatic bradycardia: 2-Dimensional operative video

Background: Glossopharyngeal neuralgia is a rare neurovascular compression syndrome that can lead to paroxysmal craniofacial pain and sometimes cardiovascular symptoms.[1,2] The characteristic pathology involves a vessel (commonly a branch/loop of PICA) compressing the nerve at the root entry/exit zone at the brainstem.[1] Microvascular decompression is a commonly used treatment approach for patients that have failed conservative measures.[2] Case Description: A 72-year-old male presented to the ED following four episodes of syncope. The patient had a multi-year history of right-sided burning/stabbing pain involving the submandibular area and posterior throat. His syncope was related to symptomatic bradycardia that would occur during episodes of pain. His pain was exacerbated by speaking and swallowing and could be triggered by placing his finger in the right external auditory meatus. Interestingly, this maneuver would also trigger his bradycardia. The patient had failed previous pharmacotherapy, and a pacemaker had been placed to protect him from periods of hypotension. MRI/MRA of the brain and cervical spine were unremarkable. Due to his profoundly symptomatic status, the patient was offered a right retrosigmoid craniotomy for microvascular decompression of the right glossopharyngeal nerve. The patient had complete resolution of his pain and bradycardia immediately post-operatively. He was discharged on the second postoperative day and his pacemaker was ultimately removed. The patient continues to be pain free and off medication. Conclusion: Here we present a video case report of microvascular decompression with favorable outcome for an interesting presentation of glossopharyngeal neuralgia. The patient gave informed consent for surgery and video recording.

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Concurrent Glossopharyngeal Neuralgia and Hemi-Laryngopharyngeal Spasm (HeLPS): A Case Report and a Review of the Literature

Neurosurgery ◽

10.1093/neuros/nyz546 ◽

2019 ◽

Vol 87 (5) ◽

pp. E573-E577

Author(s):

C Michael Honey ◽

Marie T Krüger ◽

Alan R Rheaume ◽

Josue M Avecillas-Chasin ◽

Murray D Morrison ◽

...

Keyword(s):

Case Report ◽

Literature Review ◽

Microvascular Decompression ◽

Medical Condition ◽

Posterior Inferior Cerebellar Artery ◽

Cranial Nerves ◽

Conversion Disorder ◽

Glossopharyngeal Neuralgia ◽

Neurovascular Compression ◽

Patient Reported

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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Spasmodic Torticollis Due to Neurovascular Compression of the Spinal Accessory Nerve by the Anteroinferior Cerebellar Artery: Case Report

Neurosurgery ◽

10.1097/00006123-200009000-00049 ◽

2000 ◽

Vol 47 (3) ◽

pp. 768-772 ◽

Cited By ~ 1

Author(s):

Concetta Alafaci ◽

Francesco M. Salpietro ◽

Gaspare Montemagno ◽

Giovanni Grasso ◽

Francesco Tomasello

Keyword(s):

Cranial Nerve ◽

Neuromuscular Disorder ◽

Spasmodic Torticollis ◽

Accessory Nerve ◽

Decompression Surgery ◽

Neurovascular Compression ◽

Cerebellar Artery ◽

History Of ◽

Microvascular Decompression Surgery ◽

The Right

ABSTRACT OBJECTIVE AND IMPORTANCE Spasmodic torticollis is a neuromuscular disorder characterized by uncontrollable clonic and intermittently tonic spasm of the neck muscles. We report a case of spasmodic torticollis attributable to neurovascular compression of the right XIth cranial nerve by the right anteroinferior cerebellar artery (AICA). CLINICAL PRESENTATION A 72-year-old man with a 2-year history of right spasmodic torticollis underwent magnetic resonance imaging, which demonstrated compression of the right XIth cranial nerve by an abnormal descending loop of the right AICA. INTERVENTION The patient underwent microvascular decompression surgery. During surgery, it was confirmed that an abnormal loop of the right AICA was compressing the right accessory nerve. Compression was released by the interposition of muscle between the artery and the nerve. CONCLUSION The patient's postoperative course was uneventful, and his symptoms were fully relieved at the 2-year follow-up examination. This is the first reported case of spasmodic torticollis attributable to compression by the AICA; usually, the blood vessels involved are the vertebral artery and the posteroinferior cerebellar artery.

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Treatment of trigeminal and glossopharyngeal neuralgia in an adolescent: a case report

JA Clinical Reports ◽

10.1186/s40981-021-00465-5 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Aiko Maeda ◽

Kenzo Araki ◽

Chiaki Yamada ◽

Shoko Nakayama ◽

Kazuhiro Shirozu ◽

...

Keyword(s):

Age Groups ◽

The Elderly ◽

Glossopharyngeal Neuralgia ◽

Neurovascular Compression ◽

Case Presentation ◽

Younger Age ◽

Combined Features ◽

The Right ◽

Symptom Recurrence

Abstract Background Hyperactive dysfunction syndrome (HDS) refers to a constellation of symptoms developing from cranial nerve overactivity caused by neurovascular compression at the root entry or exit zone near the brainstem. Although the combined features of HDS are seen in the elderly, there are no reports of such cases in adolescents, to date. Case presentation A 17-year-old male was diagnosed with right glossopharyngeal neuralgia and treated with microvascular decompression. He experienced new-onset right facial pain later and was diagnosed with right trigeminal neuralgia, which required prompt radiofrequency thermocoagulation of the right mandibular nerve. Follow-up in the third post-treatment year revealed the absence of symptom recurrence. Discussion We report the treatment of a rare case of adolescent-onset combined HDS presenting as trigeminal and glossopharyngeal neuralgia. This report highlights the possibility of combined hyperactive dysfunction syndrome in younger age groups. It is crucial to establish a diagnosis early on for prompt management.

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Drop Attack Treated by Microvascular Decompression of the Superior Vestibular Nerve

Ear Nose & Throat Journal ◽

10.1177/01455613211043672 ◽

2021 ◽

pp. 014556132110436

Author(s):

Sanghoon Kim ◽

Soo-Keun Kong ◽

Jae Meen Lee ◽

Se-Joon Oh

Keyword(s):

Microvascular Decompression ◽

Vestibular Nerve ◽

Vestibular Evoked Myogenic Potentials ◽

Anterior Inferior Cerebellar Artery ◽

Mri Findings ◽

Vestibulocochlear Nerve ◽

Drop Attack ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

The Right

We report a case of cochleovestibular neurovascular compressive syndrome (CVCS)-induced drop attack treated with microvascular decompression (MVD) of the superior vestibular nerve. This report discusses the merits of surgical intervention through a review of related literature. A 58-year-old woman was referred to our clinic with a chief complaint of intermittent, strong, right-sided tinnitus lasting for a few seconds immediately prior to drop attack. Magnetic resonance imaging (MRI) showed bilateral neurovascular contact between the anterior inferior cerebellar artery (AICA) and the vestibulocochlear nerve. Based on MRI findings, history of present illness, and response to anticonvulsants, CVCS was suspected, and surgical decompression on the right side was subsequently performed. The patient became asymptomatic immediately after the surgery, and the vestibular-evoked myogenic potentials were normalized. No recurrence was reported during a 1-year follow-up period.

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Appearance of cerebellar cyst following microvascular decompression to treat hemifacial spasm: a report of two cases and literature review

Journal of International Medical Research ◽

10.1177/0300060520932118 ◽

2020 ◽

Vol 48 (7) ◽

pp. 030006052093211

Author(s):

Yu Cui ◽

Zhong-Xi Yang ◽

Chun-Mei Wang ◽

Zhan-Peng Zhu

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Rare Complication ◽

Intracerebral Haematoma ◽

Appropriate Treatment ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Safe Approach

Microvascular decompression (MVD) is an effective and safe approach for treating hemifacial spasm (HFS). Postoperative complications may include facial nerve palsy, hearing loss, intracerebral haematoma, and brainstem infarction. The occurrence of intracranial cyst following MVD is extremely rare, with few cases documented in the literature. Herein, the cases of two patients with HFS who developed ipsilateral cerebellar cyst following MVD are reported. The first patient was a 50-year-old male presenting with a 6-year history of HFS on the right side of his face. MVD was performed, and 12 days postoperatively he developed dizziness and nausea. Magnetic resonance imaging (MRI) showed a cyst in the ipsilateral cerebellum. Antibiotic treatment provided no benefit, and the cyst was drained. The second patient was a 44-year-old female presenting with a 4-year history of HFS on the right side of her face. MVD was performed, and 18 days following surgery, she developed dizziness and nausea. MRI showed an ipsilateral cerebellar cyst. Conservative treatment was applied and the cyst shrunk. At the 2-month follow-up appointment, symptoms were completely resolved in both patients. Cerebellar cyst is a rare complication following MVD. Timely diagnosis and appropriate treatment should be emphasized, and surgical treatment may be unnecessary.

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A Perforating Artery Compressing the Nerve Rootlet and Causing Glossopharyngeal Neuralgia

Operative Neurosurgery ◽

10.1227/neu.0000000000000855 ◽

2015 ◽

Vol 11 (3) ◽

pp. 382-386 ◽

Cited By ~ 3

Author(s):

Naokado Ikeda ◽

Hiroki Toda ◽

Misaki Yamamoto ◽

Shin-ichi Kanemaru ◽

Masatsune Ishikawa ◽

...

Keyword(s):

Pain Relief ◽

Microvascular Decompression ◽

Glossopharyngeal Neuralgia ◽

Preoperative Imaging ◽

Neurovascular Compression ◽

Imaging Studies ◽

Main Trunk ◽

Perforating Artery ◽

Offending Artery ◽

Surgical Option

Abstract BACKGROUND A surgical procedure for glossopharyngeal neuralgia (GPN) was selected from microvascular decompression, glossopharyngeal and upper vagal rhizotomy, or a combination of these procedures based on the presence of arteries compressing the glossopharyngeal and vagal rootlets. The offending artery is usually a main trunk or branch of the cerebellar arteries. A perforating artery is a known but uncommon variation of the offending artery that causes GPN. The appropriate procedure for such cases is unknown. OBJECTIVE To analyze the clinical significance of the perforating artery in GPN, we describe 2 patients with a perforating artery compressing the rootlet, and its mobilization relieved neuralgia. We examined the validity of decompressing a perforating artery as an alternative to rhizotomy in such cases. METHODS We independently reviewed 12 GPN patients treated with microvascular decompression. The patients' pain severity, medication doses, preoperative imaging studies, intraoperative findings, and outcomes were examined. RESULTS Eleven patients had neurovascular compression of the glossopharyngeal nerve. In 2 of the patients, a perforating artery compressed the rootlet, thereby generating an indentation and creating a discoloration of the rootlet. Mobilizing the perforating artery with no additional rhizotomy provided complete pain relief with no significant complications and allowed the discontinuation of medications. CONCLUSION Even a small perforating artery can cause GPN when it compresses the rootlet. In such cases, mobilization of the perforating artery with no additional rhizotomy is an effective surgical option.

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A Unique Case of Microvascular Triple Decompression for Combined Simultaneous Trigeminal Neuralgia, Hemifacial Spasm, and Glossopharyngeal Neuralgia Because of the Dolichoectatic Vertebrobasilar System

Operative Neurosurgery ◽

10.1093/ons/opz205 ◽

2019 ◽

Vol 18 (6) ◽

pp. 692-697 ◽

Cited By ~ 1

Author(s):

Roberto J Perez-Roman ◽

Stephanie H Chen ◽

Samir Sur ◽

Roberto Leon-Correa ◽

Jacques J Morcos

Keyword(s):

Trigeminal Neuralgia ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Glossopharyngeal Neuralgia ◽

Complete Relief ◽

Root Entry Zone ◽

Vertebrobasilar System ◽

Effective Option ◽

The Right ◽

Surgical Treatments

Abstract BACKGROUND Trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GPN) are hyperactive dysfunction syndromes (HDS) commonly caused by microvascular compression of their root entry zone. Cases of combined HDS involving 2 or more of these entities are extremely rare. Although microvascular decompression is the surgical treatment of choice, there are additional techniques that have been described as efficient methods to accomplish vessel transposition. OBJECTIVE To our knowledge, we present the first reported case of triple simultaneous HDS successfully treated using the clip-sling technique to achieve microvascular decompression. We discuss several technical pearls and pitfalls relevant to the use of the sling suspension technique. METHODS We report the rare case of a 66-yr-old male with combined simultaneous unilateral right-sided TN, HFS, and GPN because of a dolichoectatic vertebrobasilar system compressing the exit zones of the right trigeminal, facial, and glossopharyngeal nerves and present a literature review of combined HDS and their different surgical treatments. RESULTS Symptomatic TN, HFS, and GPN have been reported 8 times in the literature with our case being the ninth. A retrosigmoid craniotomy was performed for microvascular decompression of the brainstem with a clip-sling suspension technique augmented with Teflon felt pledgets. The patient had immediate complete relief from TN, HFS, and GPN postoperatively. CONCLUSION Microvascular decompression using the clip-sling technique via a retrosigmoid approach should be considered as a safe and effective option for transposition and suspension of the offending artery and decompression of the affected nerve roots in cases of combined HDS.

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Posterior C2-6 Laminoplasty for Resection of Arteriovenous Malformation: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz403 ◽

2019 ◽

Vol 18 (3) ◽

pp. E72-E73 ◽

Cited By ~ 1

Author(s):

Benjamin K Hendricks ◽

Robert F Spetzler

Keyword(s):

Vertebral Artery ◽

Video Recording ◽

Preoperative Embolization ◽

Surgical Morbidity ◽

Imaging Evaluation ◽

Institutional Review ◽

Long Term Follow Up ◽

History Of ◽

Surgical Cure ◽

The Right

Abstract Large extramedullary-intramedullary arteriovenous malformations (AVMs) within the spinal cord provide a unique management opportunity, compared with the cranial counterpart, in that the surgical morbidity can be minimized and surgical cure can still be achieved by resecting the extramedullary segment and leaving the intramedullary segment without invading the parenchyma. This management strategy minimizes morbidity and provides an excellent chance of surgical cure. This patient had a history of longstanding left hemiparesis since birth that progressed, prompting imaging evaluation that demonstrated a large cervical AVM with bilateral vertebral artery, anterior spinal artery, and left thyrocervical trunk feeding vessels. The AVM had both extramedullary and intramedullary components, making this a challenging lesion for microsurgical obliteration and preservation of neurological function. Preoperative embolization was utilized through the right vertebral artery pedicle. Microdissection was performed to isolate the extramedullary from the intramedullary component. Surgical cure was attempted for this patient by removing the extramedullary component and leaving the intramedullary segment. Indocyanine green fluoroscopy was used to isolate the feeding pedicle and guide surgical resection. Postoperative imaging demonstrated a small residual from the thyrocervical injection, which was obliterated with embolization. The patient improved neurologically within the postoperative period and regained ambulatory status during long-term follow-up. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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Z-line degradation and phagocytosis of sarcomeric fragments in myonecrosis

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100077529 ◽

1983 ◽

Vol 41 ◽

pp. 790-791

Author(s):

Melinda L. Estes ◽

Samuel M. Chou

Keyword(s):

Vastus Lateralis ◽

Inflammatory Myopathy ◽

Muscle Disease ◽

White Female ◽

Inflammatory Cell Infiltrate ◽

Limb Weakness ◽

Muscle Diseases ◽

History Of ◽

The Right ◽

Mononuclear Inflammatory Cell

Many muscle diseases show common pathological features although their etiology is different. In primary muscle diseases a characteristic finding is myofiber necrosis. The mechanism of myonecrosis is unknown. Polymyositis is a primary muscle disease characterized by acute and subacute degeneration as well as regeneration of muscle fibers coupled with an inflammatory infiltrate. We present a case of polymyositis with unusual ultrastructural features indicative of the basic pathogenetic process involved in myonecrosis.The patient is a 63-year-old white female with a one history of proximal limb weakness, weight loss and fatigue. Examination revealed mild proximal weakness and diminished deep tendon reflexes. Her creatine kinase was 1800 mU/ml (normal < 140 mU/ml) and electromyography was consistent with an inflammatory myopathy which was verified by light microscopy on biopsy muscle. Ultrastructural study of necrotizing myofiber, from the right vastus lateralis, showed: (1) degradation of the Z-lines with preservation of the adjacent Abands including M-lines and H-bands, (Fig. 1), (2) fracture of the sarcomeres at the I-bands with disappearance of the Z-lines, (Fig. 2), (3) fragmented sarcomeres without I-bands, engulfed by invading phagocytes, (Fig. 3, a & b ), and (4) mononuclear inflammatory cell infiltrate in the endomysium.

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Popliteal artery thrombosis secondary to a tibial osteochondroma

VASA ◽

10.1024/0301-1526/a000101 ◽

2011 ◽

Vol 40 (3) ◽

pp. 251-255 ◽

Cited By ~ 4

Author(s):

Gruber-Szydlo ◽

Poreba ◽

Belowska-Bien ◽

Derkacz ◽

Badowski ◽

...

Keyword(s):

Case Report ◽

Magnetic Resonance Angiography ◽

Popliteal Artery ◽

Doppler Ultrasonography ◽

Histopathological Examination ◽

Previous History ◽

Plain Radiography ◽

Artery Thrombosis ◽

History Of ◽

The Right

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

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