Gamma knife radiosurgery for recurrent glossopharyngeal neuralgia after microvascular decompression.
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.


CONCLUSIONS
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.
Department of Radiation Oncology, University of California Davis, Sacramento, CA 95817, USA. sinisamd@gmail.com
Sinisa
S
Stanic
Stephen D
SD
Franklin
Conrad T
CT
Pappas
Robin L
RL
Stern
D020435:Glossopharyngeal Nerve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery; D008875:Middle Aged; D010147:Pain Measurement; D016634:Radiosurgery / Q000295:instrumentation*; D012008:Recurrence; D016896:Treatment Outcome