Reoperation for Glossopharyngeal Neuralgia

Objective: To discuss reexploration for recurrent glossopharyngeal neuralgia, whose current role is not well defined. Study Design: Case presentation. Material and Methods: A 22-year-old female with bilateral sharp pain located in retroauricular, retromandibular, and deep pharyngeal areas since 14 years. She had pain episodes almost daily requiring frequent emergency department admissions. She had previous multiple evaluations in other institutions throughout United States with neurologists, pain clinics, and neurosurgeons, had upper cervical spinal cord stimulator trials, and later underwent to staged bilateral microvascular decompression for glossopharyngeal neuralgia in one institution in 2010, and later left-sided reoperation in another institution in March, 2013. Persisted with right-sided symptoms, and managed with maximal doses of narcotics. Results: Performed right-sided reexploration with glossopharyngeal rhizotomy, as well as section of upper rootlet of vagal nerve under electrophysiology monitoring including facial nerve, auditory evoked responses, and vagal nerve monitoring (video available). Pain resolved after surgery. Conclusions: Glossopharyngeal neuralgia is a rare condition, and after adequate diagnosis the first recommendation is microvascular decompression or possible rhizotomy, if the trajectory of glossopharyngeal nerve or upper rootlets of vagal nerve are altered with Teflon pledges. A reexploration will recommend rhizotomy to decrease chance of recurrence, and in either initial operation, or reexploration, electrophysiology monitoring is recommended.