Microvascular decompression in the management of glossopharyngeal neuralgia: Analysis of 217 cases

OBJECTIVE: Glossopharyngeal neuralgia (GPN) is a rare condition that often presents with the seemingly benign symptom of deep throat pain. Medical management of this condition has not been very effective, and surgical therapy has ranged from nerve sectioning to microvascular decompression (MVD). We present our experience with more than 200 patients who underwent MVD for treatment of GPN at our institution. METHODS: We conducted a retrospective review of our database and identified patients who presented for treatment of presumed GPN. When possible, patients were contacted by telephone for collection of follow-up information regarding symptom relief, complications, functional outcomes, and patient satisfaction. Univariate and multivariate analyses were performed to identify predictors of good outcomes after MVD. Subgroup analyses were performed with quartiles of approximately 50 patients each, for assessment of the effects of improvements in techniques and anesthesia during this 20-year period. RESULTS: We observed GPN to be more common among female (66.8%) than male (33.2%) patients, with an overall mean patient age of 50.2 years (standard deviation, 14.4 yr). The most common presenting symptoms were throat and ear pain and throat pain alone, and the mean duration of symptoms was 5.7 years (standard deviation, 5.8 yr; range, 1-32 yr). Symptoms appeared almost equally on the left side (54.8%) and the right side (45.2%). The overall immediate success rate exceeded 90%, and long-term patient outcomes and satisfaction were best for the typical GPN group (with pain restricted to the throat and palate). Complication rates decreased across quartiles for all categories evaluated. CONCLUSION: MVD is a safe, effective form of therapy for GPN. It may be most beneficial for patients with typical GPN, especially when symptoms are restricted to deep throat pain only.