Experience and Efficacy Evaluation of Microvascular Decompression and Selective Nerve Root Dissection in the Treatment of Trigeminal Neuralgia Combined With Glossopharyngeal Neuralgia.

PURPOSE: This study analyzes the diagnostic challenges and treatment methods for trigeminal neuralgia (TN) concurrent with glossopharyngeal neuralgia (GPN), particularly the application and efficacy of selective glossopharyngeal rhizotomy in addressing this complex condition.

METHODS

The study reviews the clinical data of 53 patients with TN concurrent with GPN who were treated at the Department of Oral and Maxillofacial Surgery in the Ninth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine from 2011 to 2022. These patients underwent microvascular decompression (MVD) via a retrosigmoid approach for TN and selective glossopharyngeal rhizotomy under electrophysiological monitoring for GPN. Surgical outcomes were evaluated with the efficacy evaluation method of Kuncz based on the degree of pain relief.

RESULTS

Postoperatively, surgical outcomes were excellent in 46 patients (86.8%), good in 6 patients (11.4%), and poor in 1 patient (1.8%). Patients developed complications including facial numbness (30.2%), hoarseness and coughing (9.4%), and facial paralysis (3.8%), most of which recovered after a period of time postoperatively. Long-term follow-up exhibited an effective rate of 98.2%.

CONCLUSIONS

For patients with TN concurrent with GPN who are unresponsive to pharmacologic therapy, MVD for TN combined with selective glossopharyngeal rhizotomy under electrophysiological monitoring can achieve a high rate of pain relief with a low complication rate. Of note, the intraoperative application of electrophysiological monitoring can elevate the safety and success rate of surgery. Accordingly, this comprehensive treatment approach deserves further promotion and application in clinical practice.