Surgical management for glossopharyngeal neuralgia associated with cardiac syncope: two case reports

Esaki, Toshio; Osada, Hiroaki; Nakao, Yasuo; Yamamoto, Tsunehisa; Maeda, Motohiro; Miyazaki, Tadashi; Sumiyoshi, Masataka; Mori, Koichi

doi:10.1080/02688690701627138

Cited by 25 publications

(16 citation statements)

References 22 publications

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“…39 Since that time, this operation has gained greater acceptance than the traditional rhizotomy procedures and many series have been published regard ing its efficacy. [15][16][17]26,30,34,39,[45][46][47]50,56,60,67 Percutaneous procedures have been devised as an alternative to craniotomy; these procedures include ra diofrequency rhizotomy 2,4,12,18,21,40,55 and trigeminal trac totomy. 27,28,38 Most recently, stereotactic radiosurgery has also been explored.…”

Section: 41mentioning

confidence: 99%

“…4 Glossopharyngeal neuralgia can lead to bradycardia and loss of sympathetic tone, and therefore syncopal episodes and even seizures occur in as many as 10% of the cases. 1,3,12,14,35,58,63,68 In rare cases GPN can present as syncope with no associated pain syn drome, 49 making the diagnosis even more difficult. Like TN, GPN is treated using anticonvulsant medications, but this latter condition tends to be more refractory to medi cal therapy, especially in patients with vascular compres sion.…”

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confidence: 99%

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Current neurosurgical management of glossopharyngeal neuralgia and technical nuances for microvascular decompression surgery

Rey‐Dios

Cohen-Gadol

2013

FOC

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Glossopharyngeal neuralgia (GPN) is an uncommon facial pain syndrome often misdiagnosed as trigeminal neuralgia. The rarity of this condition and its overlap with other cranial nerve hyperactivity syndromes often leads to a significant delay in diagnosis. The surgical procedures with the highest rates of pain relief for GPN are rhizotomy and microvascular decompression (MVD) of cranial nerves IX and X. Neurovascular conflict at the level of the root exit zone of these cranial nerves is believed to be the cause of this pain syndrome in most cases. Vagus nerve rhizotomy is usually reserved for cases in which vascular conflict is not evident. A review of the literature reveals that although the addition of cranial nerve X rhizotomy may improve the chances of long-term pain control, this maneuver also increases the risk of permanent dysphagia and vocal cord paralysis. The risks of this procedure have to be carefully weighed against its benefits. Based on the authors' experience, careful patient selection with a thorough exploratory operation most often leads to identification of the site of vascular conflict, obviating the need for cranial nerve X rhizotomy.

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Section: 41mentioning

confidence: 99%

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confidence: 99%

Current neurosurgical management of glossopharyngeal neuralgia and technical nuances for microvascular decompression surgery

Rey‐Dios

Cohen-Gadol

2013

FOC

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“…Vascular compression of the hypoglossal nerve can lead to hemilingual spasms exacerbated by talking, chewing, or emotional stress; 19 likewise, compression of the accessory nerve has been documented to result in spastic torticollis. 13,32 Finally, compression of the vagus nerve can result in presyncopal and syncopal episodes concomitant with glossopharyngeal neuralgia or hemifacial spasm, 8,28,30 intractable hiccups, 9,14 or dysphagia. 15 There have been additional reports of dolichoectatic vessels, most commonly the vertebral artery, that cause brainstem compression producing neurological dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Resolution of intractable retching following mobilization of a dolichoectatic vertebral artery: case report of a unique brainstem–cranial nerve compression syndrome

Seaman

Nelson

Alexander

et al. 2017

Journal of Neurosurgery

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The authors present the case of a 53-year-old man who was referred with disabling retching provoked by left arm abduction. At the time of his initial evaluation, a cervical MRI study was available for review and revealed an anatomical variation of the ipsilateral juxtamedullary vertebrobasilar junction. After brain imaging revealed contact of the medulla by a dolichoectatic vertebral artery at the dorsal root entry zone of the glossopharyngeal and vagus nerves, the patient was successfully treated by microvascular decompression of the brainstem and cranial nerves. This case demonstrates how a dolichoectatic vertebral artery-a common anatomical variation that typically has no clinical consequence-should be considered in cases of cranial nerve dysfunction.

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“…19 There are many well-documented cases of syncope associated with vagoglossopharyngeal neuralgia. [20][21][22][23] The pathophysiology is explained by the close connections that exist between the glossopharyngeal nerve and the vagus nerve. The general visceral afferent component of cranial nerve IX (glossopharyngeal) receives viscerosensory input from the carotid sinus baroreceptors as well as tactile sensation from the posterior third of tongue, pharynx, middle ear, and Eustachian tube.…”

Section: Discussionmentioning

confidence: 99%

Vagoglossopharyngeal-Associated Syncope Due to a Retained Bullet in the Jugular Foramen

Link¹,

Driscoll²,

Esquenazi³

2009

Skull Base

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Gunshot wounds (GSWs) to the head are frequently fatal. Rarely, the bullet may lodge in the skull base and not cause significant brain injury. Typically, the bullet fragments are felt to be inert and do not require operative extirpation if they are within the bony confines of the skull base. We report the case of a bullet in the jugular foramen causing recurrent syncope that resolved after surgical removal of the bullet. The medical records from a patient who suffered a GSW to the head were retrospectively reviewed and the treatment and outcome documented. In 2000, a 20-year-old man suffered a GSW to the head. Immediate evaluation revealed the bullet in the right skull base at the jugular foramen, but no parenchymal brain injury. One year after the GSW, he began to experience stereotypical spells resulting in loss of consciousness. Extensive cardiovascular workup was normal. In 2002, the patient underwent removal of the bullet. He has been syncope-free since the operation and returned to his career in the military. We believe the retained bullet in this patient was irritating the IX-X cranial nerves, resulting in syncope, similar to the mechanism in vagoglossopharyngeal neuralgia. Removing the bullet relieved the irritation and stopped the syncopal spells.

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Surgical management for glossopharyngeal neuralgia associated with cardiac syncope: two case reports

Cited by 25 publications

References 22 publications

Current neurosurgical management of glossopharyngeal neuralgia and technical nuances for microvascular decompression surgery

Current neurosurgical management of glossopharyngeal neuralgia and technical nuances for microvascular decompression surgery

Resolution of intractable retching following mobilization of a dolichoectatic vertebral artery: case report of a unique brainstem–cranial nerve compression syndrome

Vagoglossopharyngeal-Associated Syncope Due to a Retained Bullet in the Jugular Foramen

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