DOI: 10.1097/pr9.0000000000001496 ISSN: 2471-2531

Long-term outcomes of microvascular decompression vs neurotomy for glossopharyngeal neuralgia: a multicenter clinimetric study

José D. Carrillo-Ruiz, Carlos Barzallo-Sacoto, Álvaro Diego Rivera-Arroyo, Noé Pérez-Carrillo, Abel Olivares-Quezada, Naomi Contreras-Galván, Miguel Jiménez-Olvera, Francisco Velasco-Campos, Fiacro Jiménez-Ponce, José L. Navarro-Olvera, Jesús Q. Beltrán, Gustavo Aguado Carrillo
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Abstract

Introduction:

Glossopharyngeal neuralgia (GPN) is a rare cranial pain syndrome, with limited comparative long-term evidence for microvascular decompression (MVD) and neurotomy (NT).

Objectives:

To compare clinimetric outcomes of microvascular decompression (MVD) and neurotomy (NT) in patients with glossopharyngeal neuralgia (GPN).

Methods:

Analytical ambispective multicenter study (1990–2024) including patients with GPN treated with MVD or NT across 3 international neurosurgical centers. Pharmacological treatment history was recorded. Pain intensity was assessed pre- and postoperatively using the Visual Analog Scale (VAS) and Barrow Neurological Institute-Pain Intensity Score. Positive sensory symptoms (PSS) including allodynia, dysesthesia, and paresthesia were evaluated when data were available.

Results:

From a total of 93 medical records, 25 patients underwent surgery; 23 met inclusion criteria (MVD = 12, NT = 11) and were evaluated long-term. Patients had a mean age of 58.48 ± 14.33 years, and follow-up ranged from 6 months to 14 years (mean 5.2 ± 4.52). All patients were refractory to pharmacotherapy. Overall VAS scores decreased from 4 to 10 (mode 10) preoperatively to 0 to 5 (mode 0) postoperatively ( P = 2.38 × 10 −7 ). In the MVD group, VAS decreased from 4 to 10 to 0 to 5 ( P = 0.00049), and in the NT group from 8 to 10 to 0 to 4 ( P = 0.00098), with no significant difference in postoperative scores between groups ( P = 0.913). Positive sensory symptoms were assessed in 12 patients (52.17%); 9 (75%) presented ≥1 preoperatively (100% allodynia, 77.8% dysesthesia, 22.2% paresthesia). Postoperatively, only 1 patient (8.3%) had persistent dysesthesia and paresthesia.

Conclusions:

Both MVD and NT are highly effective in reducing pain and PSS in GPN, with comparable postoperative outcomes. Limitations include small sample size and ambispective design.

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