Surgical treatment of lingopharyngeal nerve neuralgia (Sikar syndrome)

Glossopharyngeal neuralgia (GPN) is a rare disease (incidence of 16 cases per 10 000 000 population, i.e. about 50 times less frequent than trigeminal neuralgia). Glossopharyngeal neuralgia is characterised by recurrent stereotyped unilateral painful attacks in the area of the palatine tonsil, root of the tongue and the lateral part of the pharynx, irradiating to the ear. It is often precipitated by talking, swallowing and chewing movements, touching the zones of innervation of the IX nerve. Materials and Methods. From 2014 to the present, 12 patients with glossopharyngeal neuralgia were operated on at the Centre of Neurosurgery named after N. N. Burdenko. Women (7 women and 5 men) aged from 39 to 69 years (mean age 48 years) slightly prevailed in the study group. The intensity of pain syndrome was assessed by Visual Analogue Scale (VAS). All patients underwent preoperative brain MRI in FIESTA/CISS modes, as well as contrast-enhanced MRI of soft tissues of the neck, neurological examination, and otorhinolaryngological examination. Patients of the study group underwent microsurgical vascular decompression of the glossopharyngeal nerve withprotector placement through suboccipital retrosigmoid access. T welve patients were included in the catamnestic group. The periods of dynamic follow-up ranged from 1 month to 10 years (the average period was 5 years). Results. In the postoperative period complete regression of the pain syndrome was obtained in 92% of cases. In the remaining cases a significant reduction of the bulbar palsy according to the VAS scale was noted.In the postoperative period hearing reduction was revealed in 1 patient (8 %), in 2 patients there were coarse bulbar disorders (swallowing disorder, choking, feeling of a lump in the throat, coughing) (16 %). The most persistent character had acusia and bulbar disorders observed in the remote period. According to the data of the catamnestic study the positive result (regression of the pain syndrome) persisted in all patients. Conclusions. Vascular decompression is the only effective pathogenetic method of treatment of glossopharyngeal neuralgia, which relieves patients from debilitating pain syndrome. At the same time, bulbar palsy, which occur in some patients after the operation, are persistent, but subjectively bother patients to a much less extent than the initial pain syndrome.