%0 Journal Article
%T Gamma Knife radiosurgery for glossopharyngeal neuralgia: A study of 21 patients with long
%A Anne Donnet
%A Antoine Dorenlot
%A Constantin Tuleasca
%A Jean Regis
%A Laura Negretti
%A Luis Schiappacasse
%A Marc Levivier
%A Maud Marguet
%A Michele Zeverino
%A Pierre-Yves Borius
%A Xavier Muraciole
%J Cephalalgia
%@ 1468-2982
%D 2018
%R 10.1177/0333102417698961
%X Glossopharyngeal neuralgia (GPN) is a very rare condition, affecting the patient¡¯s quality of life. We report our experience in drug-resistant, idiopathic GPN, treated with Gamma Knife radiosurgery (GKRS), in terms of safety and efficiency, on a very long-term basis. The study was opened, self-controlled, non-comparative and bicentric (Marseille and Lausanne University Hospitals). Patients treated with GKRS between 2003 and 2015 (models C, 4C and Perfexion) were included. A single 4-mm isocentre was positioned in the cisternal portion of the glossopharyngeal nerve, with a targeting based both on magnetic resonance imaging (MRI) and computed tomography (CT). The mean maximal dose delivered was 81.4£¿¡À£¿6.7£¿Gy (median£¿=£¿85£¿Gy, range£¿=£¿60¨C90£¿Gy at the 100% isodose line). Twenty-one patients (11 women, 10 men) benefited from 25 procedures. The mean follow-up period was 5.2£¿¡À£¿3 years (range£¿=£¿0.9¨C12.1 years). Seventeen (81%) were initially pain-free after GKRS. At three months, six months and one year after radiosurgery, the percentage of patients with good outcome (BNI classes I to IIIA) was 87.6%, 100% and 81.8%, respectively. Ten cases (58.8%) from the initial pain-free ones had a recurrence, after a mean period of 13.6£¿¡À£¿10.4 months (range£¿=£¿3.1¨C36.6 months). Only three patients (14.2%) had recurrences (two for each one of them) requiring further surgeries. Three patients underwent a second GKRS procedure; one case needed a third GKRS. The former procedures were performed at 7, 17, 19 and 30 months after the first one, respectively. Furthermore, two patients needed additional interventions. At last follow-up, 17 cases (80.9%) were still pain-free without medication. The actuarial pain relief without new surgery was 83%. A transient complication (paraesthesia of the edge of the tongue) was seen in one case (4.8%). GKRS is a valuable, minimally invasive, surgical alternative for idiopathic GPN, with a very high short- and long-term efficacy and without permanent complications. A quality imaging, including T2 CISS/Fiesta MRI and bone CT acquisitions for good visualisation of the nerve and the other bony anatomic landmarks, is essential for targeting accuracy and successful therapy
%K Pain
%K glossopharyngeal neuralgia
%K radiosurgery
%K Gamma Knife radiosurgery
%U https://journals.sagepub.com/doi/full/10.1177/0333102417698961