Microvascular decompression for glossopharyngeal neuralgia in a single center (A20211204 )
Microvascular decompression for glossopharyngeal neuralgia in a single center at Word Neurosurgery Webinar Conference 2021 The purpose of this study is to describe our results of microvascular decompression (MVD) to treat glossopharyngeal neuralgia (GPN), as well as to inform the findings during this surgery and the outcomes. Method: From August 2016 to October 2021, 94 patients were diagnosed with GPN; 37 (39%) in its classic form and 57 (61%) in combination with other neuropathies. DMV was performed in 29 patients. Age, sex, time of evolution of the symptoms, intraoperative findings and post-operative results were evaluated. Result: The mean age of patients was 56.5 years old and the average time of the evolution of the symptoms was 7.5 years. Most of the patients were female (52%), and the right side was the more affected (62%). Comorbidities were presented in 52% of patients highlighting systemic arterial hypertension, diabetes mellitus and dyslipidemia. The leading cause of compression was SCA, followed by PICA, AICA and vertebral artery. Other findings included arachnoiditis (92%), mainly viscous with signs of fibrosis and/or microcalcifications. Complications were reported in 5 patients (17.2%); those included CSF fistula or facial palsy. All patients presented immediate improvement of the GPN symptoms after surgery, 20 (68.9%) reported themselves without pain, 2 (6.9%) presented with mild pain with no medication requirement, 3 (10.3%) moderate pain adequately controlled with medication, 2 (6.9%) were candidates to radiofrequency thermoablation due to residual pain, and in 2 (6.9%) patients the follow-up was lost. Conclusion: Minimally invasive MVD as a treatment for GPN is an effective and safe procedure allowing a good resolution of symptoms in most cases. Keywords: microvascular decompression, glossopharyngeal neuralgia, neuropathy Neurología Segura Medical Center www.neurologiasegura.net
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Microvascular decompression for glossopharyngeal neuralgia in a single center (A20211204 )
- 1. Microvascular decompression for glossopharyngeal neuralgia in a single center. Adriana Fernanda Segura-Zenón, MS Mauro A. Segura-Lozano, MD, PhD; Aarón G. Munguía-Rodríguez, PhD. Neurología Segura Medical Center México Dec 4th, 2021 11th Virtual International Conference of the Neurosurgery Research Listserv World Neurosurgery Webinar Conference 2021 Investigación Segura
- 2. A disorder characterized by unilateral brief stabbing pain, abrupt in onset and termination, in the distribution of the glossopharyngeal nerve. Pain is experienced in the ear, base of the tongue, tonsillar fossa and/or beneath the angle of the jaw. Definition Hartmut Gobel, 13.2.1 Glossopharyngeal neuralgia - ICHD-3
- 3. Introduction In 1910, Weissenberg first described GFN as "essential pharyngeal veil” pain. In 1920, Sicard and Robineau were the first to describe a surgical intervention for patients with glossopharyngeal neuralgia by dissecting the pharyngeal nerve and branch of the vagus nerve in the neck. Dandy, in 1927, performed an intracranial rhizotomy (cisternal neurothomy) of the glossopharyngeal nerve fibers as a treatment. In 1977, Jannetta observed compression of the glossopharyngeal nerve by the vertebral artery and the etiology of this disease became known. Laha & Jannetta initiated the first non-destructive treatment for NGF.
- 4. The purpose of this study is to describe our results of microvascular decompression (MVD) to treat glossopharyngeal neuralgia (GPN), as well as to inform the surgical findings and our outcome. Objective
- 5. Method GPN Types 37 57 Simple GPN Combined GPN + other neuropathies N=94 n=29
- 7. Results 52% 48% Gender Female Male 62% 38% Affected side Right Left 0 10 20 30 40 50 60 70 80 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Age 0 5 10 15 20 25 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Evolution of the symptoms.
- 9. Results Surgical vascular findings • SCA • PICA • AICA • VA
- 11. Diagnosis
- 12. 83% 17% Facial palsy 20% CSF fistula 20% Vomiting, nausea, headache. 60% 48h post operative evolution n=5 N=29
- 13. No pain, no medication requirement. Mild pain, no medication requirement. Moderate pain, controlled with medication. Residual pain, no controled with medication. Outcome 68.9% 6.9% 10.3% 6.9% RF
- 14. Conclusion The minimally invasive MVD as the first election surgical treatment for GPN as the most effective and safe surgical procedure allowing a good resolution of symptoms up to 93% of our serie of cases. We do not recommend the neurotomy/rizothomy of the CN IX due to the transient secondary sequelas. A more detailed analysis could be done in order to find any possible relation among the surgical and histopathological findings with the long time outcome.
- 15. Matilde Petra Montoya Lafruaga 1857-1938 "Men and women should have the same intellectual and civil rights"
Notes de l'éditeur
- Our method was based on a period of time from August 2016 to October 2021, 94 patients were diagnosed with GPN; where 37 (39%) were diagnosed with GPN in its classic form and 57 (61%) in combination with other neuropathies. of which 29 patients was our sample in this studio, they are pacients who underwent to MVD and fullfild inclusion criteria such as: Complete clinical record, MRI disk imaging studies, surgery report with video and drawing, histopathological report. And follow-up of at least one year Age, sex, time of evolution of the symptoms, intraoperative findings and post-operative results were evaluated.
- The leading cause of compression was superior cerebellar artery , followed by Posterior inferior cerebellar artery, anterior inferior cerebellar artery and vertebral artery.
- Other findings included arachnoiditis (ARACNOIDAITIS( (92%), mainly viscous (ˈviskəs) with signs of fibrosis (FAIBROSES) and/or microcalcifications as you can see in the images. MACROSCOPIC INFORMATION WITH HISTOPATHOLOGICAL FINDINGS WILL BE REVIEWED AND ANALYZED in another study to relate HOW THEY AFFECT THE EVOLUTION of the patient.
- diagnosis will be clinical , and MRI will hep us to confirm/support the diagnosis of gpn Nevertheless vascular contact cannot always be observed until surgery. Look at this 3D FIESTA MRI at the level of the jugular foreimen, and note the right side of a px where we can see how vascular contact looks like, in this case from Posterior inferior cerebellar artery (PICA) direct branch of the VA
- Let's move to the post operative evolution on the fist 48hours of the patients who underwent the surgery. 5 patients presented Vomiting, nausea, headach hey were treated with antihemetics and analgesics (17.2%). Major complications such as Cerebrospinal fluid fistula ocurred in one pacient and required reoperation. Also one pacient presented transitory facial paralysis.
- We use the following classification to capture the results of all our patients after surgery: All patients presented immediate improvement of the GPN symptoms after surgery, almost 70% of them reported themselves without pain, 2 (6.9%) reported themselves with mild pain but no medication requirement , 3 (10.3%) preported moderate pain adequately controlled with medication → and here I would like to emphasize that these patients have been using drugs that do not relieve pain for years (on average 7.5)and now after mvd they do not need it or the pain is finally controlled with medication, finaly 2 (6.9%) were candidates to radiofrequency thermoablation due to residual pain (most of them are parte of our 52% of px with comorbilities) and in 2 (6.9%) patients the follow-up was lost
- COCLUSIONES DE ESTUDIO PRE ELIMINAR, QUE REQUIERE UNA MUESTR MAS GRANDE. We conclude that Minimali inveisiv microbascular decompresion as the first election surgical treatment fot gpn is the most effective and safe surgical procidiur allowing a good resolution of symtoms in most cases. We do not recomend the neurothomy of the gp nerve due to the transient secundary sequelas. A more detailed analysis could be done in order to find any possible relation among the surgical and histopathological findings with the long time outcome
- I want to finish this session with matilde petra montoya lafruaga, She was the first female doctor in Mexico from the National School of Medicine WHERE IN THOSE TIMES THE participation of women was not approved BUT MATILDE FOUGHT TO ACHIEVE HER GOAL OF BEING A DOCTOR AND Before 1887 there was not a single female physician in the entire country so she made history and forever changed the course of medicine. thanks to her, doors were opened for many Mexican WIMEN on the path of medicine ,science and knowledge. She used to said “"Men and WIMEN should have the same intellectual and civil rights" Thank you very much, here its our e mail, where you can write us and leave us any question, we will be pleased to answer all of your questions as soon as possible