Computed tomography-guided trigeminal tractotomy-nucleotomy in the management of vagoglossopharyngeal and geniculate neuralgias.
OBJECTIVE
Vagoglossopharyngeal and geniculate neuralgias are less frequently seen types of cranial neuralgias. Their causes and symptomatology are similar to those of trigeminal neuralgia; however, the complex anatomic relationship between the intermedius, vagal, and glossopharyngeal nerves leads to difficulties in the diagnosis and management of neuralgias originating from these cranial nerves. Numerous procedures have been used to treat intractable neuralgias of the VIIth, IXth, and Xth cranial nerves: 1) extracranial sectioning of the cranial nerves, 2) percutaneous thermal rhizotomy, 3) intracranial glossopharyngeal and vagal rhizotomies, 4) microvascular decompression, and 5) percutaneous trigeminal tractotomy-nucleotomy (TR-NC) or nucleus caudalis dorsal root entry zone operation. We propose that computer-guided TR-NC may be the first-choice operation for patients with glossopharyngeal, vagal, or geniculate neuralgia.


METHODS
Nine patients suffering from idiopathic vagoglossopharyngeal neuralgia (six patients) and geniculate neuralgia (three patients) were managed at our clinic. Computed tomography-guided percutaneous trigeminal TR-NC was performed for these nine patients.


RESULTS
Excellent (six patients) or good (three patients) pain control was obtained in each patient. Complications included temporary ataxia in two patients after TR-NC.


CONCLUSIONS
The risk:benefit ratio should be evaluated individually to select the appropriate treatment procedure for patients with vagoglossopharyngeal and geniculate neuralgias. Computed tomography-guided percutaneous TR-NC is an effective and minimally invasive procedure for such patients.
Kanpolat
Y
Y
Department of Neurosurgery, Ankara University, School of Medicine, Turkey.
Savas
A
A
Batay
F
F
Sinav
A
A
D000328:Adult; D005260:Female; D005829:Geniculate Bodies; D005930:Glossopharyngeal Nerve; D006801:Humans; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D009437:Neuralgia / Q000601:surgery*; D010166:Palliative Care; D016634:Radiosurgery; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014279:Trigeminal Nucleus, Spinal / Q000000981:diagnostic imaging / Q000601:surgery*; D014630:Vagus Nerve