The Clinical Analysis Of Microsurgery Treatment To Primary Glossopharyngeal Neuralgia

Purpose: to discuss the causes, clinical characteristics and the relative treatment ofglossopharyngeal neuralgia; to observe the therapeutic effect and the safety ofmicrosurgery treatment to glossopharyngeal neuralgia and to further spread theapplication of microsurgery treatment to glossopharyngeal neuralgia which lay theclinical foundation for the diagnostic methods and therapeutic efficacy.Methods：56patients of glossopharyngeal neuralgia from Neurological Surgery,People Hospital of Liaoning Province, were taken as research subjects. The suboccipitalretrosigmoid approach used to treat, and the clinical materials, the follow-up visitscollected by the patients’ records, PDG, operation videos to analyze and discuss.Result：The courses of disease of56patients are different,1-240months, averagesymptoms last60months. The entire patients meet with the standard of HIS diagnose tothe glossopharyngeal neuralgia, excluding other causes of disease by the preoperativeroutine CT and NMRS. The suboccipital retrosigmoid approach was adopted, and theglossopharyngeal nerve root into the Pons appeared under the microscope, to observethe relations between the nerve roots and the surrounding veins. Glossopharyngealnerve root was removed for26patients, microsurgical vascular decompressioncombining with glossopharyngeal nerve root removal for30patients. If thecommunicating branch in glossopharyngeal nerve and vagas nerve found during theoperation, remove1-2filament of nearby vagas nerve.The pain symptom of56patients all disappear, cure rate100%. Complicationincludes dysphasia, drinking water choke, hoarseness,6cases(10.7%), asepticmeningitis,1case(1.8%), CFS leak,1case,(1.8%), intracranial hemorrhage,1case(1.8%), infection of incisional wound,1case(1.8%), no death case.The follow-up visits for all patients last2-88months, average visits time42months, the result is no recurrence of56cases.3cases symptoms (5.4%) of cranial verve dysfunction of6cases after operation disappear during follow-up visits,2cases(3.6%) alleviate, and1cases no change. All of them have no serious effect of theirquality life.Conclusion：Glossopharyngeal nerve root removal can be the prior way to treatthe glossopharyngeal neuralgia because of safety, less complication.Nerve root removal can efficiently avoid the recurrence of pain symptom,therapeutic efficacy, more simple operation、less dangerous、less patients feeling theabnormality in pharynx compared with microsurgical vascular decompression,especially perfect for unclear responsibility of vascular compression or clear vascularcompression but because of different reasons can not fully use the compression.As for the patients who has the communication branch between vagas nerve andglossopharyngeal nerve, can efficiently avoid the recurrence of pain complication byremoving1-2filament, but if remove too much can cause series complications, such as:dysphasia、 drinking water choke、 hoarseness, etc…The suboccipital retrosigmoid approach is the comparatively ideal way to treat theglossopharyngeal neuralgia as its minor trauma、short route、 effectiveness.Skillfully master the application of microsurgery operation technique andfamiliarize anatomy structure of Pons and cerebellum angle can accurately appear theglossopharyngeal nerve root and vagas nerve upper filament, which can improve theoperation effect and reduce the operation complications.