| BackgroundContemporary medicine has developed rapidly,but pain remains a difficult problem to overcome.Neuropathic pain refers to pain caused by neuropathy and damage-related hyperalgesia and hyperalgesia in the nervous system,including peripheral nerves and any part of the central nervous system.Glossopharyngeal neuralgia is a relatively rare clinical disease,which is mainly manifested as sudden aches such as acupuncture,electric shock,knife-like or fire-like pain,which are mainly distributed in the posterior pharynx wall,tonsil fossa,soft palate,mandibular angle,posterior third of tongue,and other regions of the IX cranial nerve distribution,which can radiates to the inner ear.The onset of pain can be accompanied by the following symptoms:decreased blood pressure,slowed heart rate,syncope,dizziness,weakness,and feeling of drowsiness.Some patients suffer from long-term suffering from pain,can not get adequate nutritional supplements,lose weight,have great psychological stress or even have distortions,Seriously damage the physical and mental health of patients.Compared to the trigeminal neuralgia or hemifacial spasm,the incidence of GPN is much lower,about 1%of trigeminal neuralgia,which has been reported as 0.2-0.7/100,000/year and the age of onset is more than 40 years old.Its pathogenesis is not clear at present.It is mainly thought to be related to the demyelination of the glossopharyngeal nerve caused by nerve compression.Common compression factors include neurovascular compression,localized arachnoid thickening adhesions,tumors and local bone thickening.The diagnosis of the disease mainly depends on the symptoms of the patient at the time of the attack,such as the triggering of the trigger point,the nature of the pain,the effect of the drug treatment,and the application of 0.5%decaine throat spray test.The main treatments for this disease are to take oral antiepileptic drugs in the early stage,and to use minimally invasive surgical treatment when the drug efficacy is weakened and the drug tolerance is poor in the later stage.The latter includes microvascular decompression and percutaneous radiofrequency thermocoagulation,nerve block,stereotactic radiotherapy-gamma knife,glossopharyngeal neurotomy.MVD is currently the only surgical treatment that preserves nerve function.It was first proposed by Dandy in 1932 when treating TN,and has achieved significant results.In 1977,Laha and Jannetta proposed that GPN can be treated by surgery to reduce the pressure on the glossopharyngeal nerve by invasive vascular structures.Since then,multi-center data show that MVD has also achieved good results in the treatment of GPN,with a 5-year effective rate of more than 90%.Surgery also has some complications,such as neurological dysfunction,brain stem infarction,postoperative bleeding,intracranial infection,and cerebrospinal fluid rhinorrhea,and so on.The incidence of postoperative neurological dysfunction can be as high as 5.9%-24.2%,mainly including hoarseness,dysphagia,facial paralysis,hearing impairment,facial and throat dysfunction,etc.The incidence of hoarseness accounts for more than 50%of all neurological dysfunction,and it brings serious inconvenience to patients' work and life,and may even be permanent.There are few reports about hoarseness after MVD at home and abroad.In this study,through long-term follow-up observation of relevant patients in this unit,further analysis of possible factors for hoarseness after surgery,and we pointed out related strategies to reduce this complication,improve the level of diagnosis and treatment,and improve the quality of life of patients.PurposeTo analyze the possible factors of hoarseness after MVD treatment of GPN patients and explore measures to effectively reduce the complications,improve the level of diagnosis and treatment,and improve the quality of the patients' life.MethodThis study retrospectively analyzed 85 patients diagnosed with GPN from Jan.2006 to Jun.2019 in the Department of Neurosurgery,Qilu Hospital of Shandong University,and 4 cases of hoarseness in patients with hemifacial spasm after MVD.Based on the patient's general information,treatment effect,imaging examination,surgical strategy,distribution of responsible blood vessels,postoperative complications and corresponding measures,long-term follow-up,the relevant anatomy knowledge of the glossopharyngeal nerve and related literature in recent years,further analysis the related factors and improvement measures.ResultAfter the patient was awake after surgery,81 patients had pain relief.The immediate pain relief rate was 95.3%,of which 75 cases were cured,4 cases were significantly relieved,2 cases were partially relieved,no deaths were observed,and the follow-up time was 0.5-13 years.During the follow-up period,a total of 4 patients experienced recurrence of pain,and the long-term treatment response rate was 88.2%.9 cases had hoarseness or dysphagia after operation,and hoarseness and dysphagia occurred at the same time,accounting for 66.7%(6/9).The incidence of neurological dysfunction accounted for 56.3%(9/16)of all complications.The incidence rate of total complications was 18.8%(16/85).After treatment and exercise,4 patients recovered and 5 patients had no significant changes in hoarseness.Among them,the responsible vessels of 4 patients were VA,and 1 patient was inferior cerebellar artery.Two patients underwent simple MVD,2 patients underwent PR and VR at the same time and one patient underwent PR alone.In patients with HFS,the responsible blood vessels are related to VA,and the amount of Teflon is large,and the placement also affects the glossopharyngeal nerve out of the brain stem.ConclusionMVD has good efficacy and safety in the treatment of GPN and HFS.Postoperative hoarseness may be caused by arytenoid subluxation,surgical methods,and responsible vessels,the placement and amount of Teflon and the nucleus ambiguus under pressure. |
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