Gamma knife radiosurgery for recurrent glossopharyngeal neuralgia after microvascular decompression

Sinisa Stanic, Stephen D. Franklin, Conrad T. Pappas, Robin L Stern

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: We report the first application of Gamma Knife radiosurgery (GKR) for recurrent glossopharyngeal neuralgia (GN) after microvascular decompression (MVD). The patient is a 51-year-old male with left-sided GN. He underwent MVD and did well for almost 4 years. Later on, the patient started to experience recurrent intolerable throat pain, frequently 10/10 in intensity. Based on the application of radiosurgery for trigeminal neuralgia, GKR was offered to the patient. Methods: After careful identification of the nerve with the assistance of a neuroradiologist, we targeted the nerve root complex, which is the cisternal portion of the nerve, using the Coherent Oscillatory State Acquisition for the Manipulation of Image Contrast (COSMIC) pulse sequence with contiguous 1-mm slices obtained by an 1.5 Tesla MRI. The radiosurgery was planned utilizing the Leksell Gamma Plan version 8.1. A single shot with a 4-mm collimator was used to deliver 80 Gy to the 100% isodose line. Results: Four weeks after the treatment, the patient began to notice significant pain relief. At the 12-month follow-up, the patient's pain, which was intolerable prior to radiosurgery, was mild and occasional. Conclusion: GKR, which is now widely used for refractory trigeminal neuralgia, can be considered for refractory or recurrent GN. With a multidisciplinary approach and advanced neuroimaging, GKR is feasible for GN after MVD, despite the shortness of the intracranial cisternal nerve portion. Further studies are necessary to establish the role of GKR for refractory GN after MVD; however, given its rarity and the lack of experience with GKR for this condition, retrospective studies with dozens of patients are almost impossible at this time.

Original languageEnglish (US)
Pages (from-to)188-191
Number of pages4
JournalStereotactic and Functional Neurosurgery
Volume90
Issue number3
DOIs
StatePublished - Jun 2012

Fingerprint

Glossopharyngeal Nerve Diseases
Microvascular Decompression Surgery
Radiosurgery
Trigeminal Neuralgia
Pain
Pharynx
Neuroimaging
Retrospective Studies

Keywords

  • Gamma Knife radiosurgery
  • Glossopharyngeal neuralgia
  • Intractable pain
  • Stereotactic radiosurgery
  • Trigeminal neuralgia

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Gamma knife radiosurgery for recurrent glossopharyngeal neuralgia after microvascular decompression. / Stanic, Sinisa; Franklin, Stephen D.; Pappas, Conrad T.; Stern, Robin L.

In: Stereotactic and Functional Neurosurgery, Vol. 90, No. 3, 06.2012, p. 188-191.

Research output: Contribution to journalArticle

Stanic, Sinisa ; Franklin, Stephen D. ; Pappas, Conrad T. ; Stern, Robin L. / Gamma knife radiosurgery for recurrent glossopharyngeal neuralgia after microvascular decompression. In: Stereotactic and Functional Neurosurgery. 2012 ; Vol. 90, No. 3. pp. 188-191.
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abstract = "Background: We report the first application of Gamma Knife radiosurgery (GKR) for recurrent glossopharyngeal neuralgia (GN) after microvascular decompression (MVD). The patient is a 51-year-old male with left-sided GN. He underwent MVD and did well for almost 4 years. Later on, the patient started to experience recurrent intolerable throat pain, frequently 10/10 in intensity. Based on the application of radiosurgery for trigeminal neuralgia, GKR was offered to the patient. Methods: After careful identification of the nerve with the assistance of a neuroradiologist, we targeted the nerve root complex, which is the cisternal portion of the nerve, using the Coherent Oscillatory State Acquisition for the Manipulation of Image Contrast (COSMIC) pulse sequence with contiguous 1-mm slices obtained by an 1.5 Tesla MRI. The radiosurgery was planned utilizing the Leksell Gamma Plan version 8.1. A single shot with a 4-mm collimator was used to deliver 80 Gy to the 100{\%} isodose line. Results: Four weeks after the treatment, the patient began to notice significant pain relief. At the 12-month follow-up, the patient's pain, which was intolerable prior to radiosurgery, was mild and occasional. Conclusion: GKR, which is now widely used for refractory trigeminal neuralgia, can be considered for refractory or recurrent GN. With a multidisciplinary approach and advanced neuroimaging, GKR is feasible for GN after MVD, despite the shortness of the intracranial cisternal nerve portion. Further studies are necessary to establish the role of GKR for refractory GN after MVD; however, given its rarity and the lack of experience with GKR for this condition, retrospective studies with dozens of patients are almost impossible at this time.",
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