Glossopharyngeal neuralgia: a comprehensive single-center comparative study with trigeminal neuralgia.

INTRODUCTION: There is limited data on long-term outcome of microvascular decompression (MVD) for refractory glossopharyngeal neuralgia (GN). There are no prospective or comparative studies. Here, we evaluate the effectiveness, safety, and long-term outcome of MVD in a consecutive series of patients with medically refractory GN and compare the results with matched patients undergoing MVD for trigeminal neuralgia (TN). METHODS: Overall, 11 patients with GN underwent MVD who were matched by age and sex with 44 TN patients. Data included demographic features, pain characteristics, intraoperative findings, and clinical outcomes. Pain relief was assessed using the modified Barrow Neurological Institute (BNI) pain scale, with scores I-III defined as good outcome. RESULTS: The mean age of patients with GN at the time of surgery was 58 years (range, 44-68), with a mean pain duration of 47 months (6 to 192 months). All patients had arterial compression, most commonly from the posterior inferior cerebellar artery (10/11), followed by the vertebral artery (5/11). Arachnoid adhesions were present in both GN and TN groups. Immediate pain relief occurred in 10/11 patients, with good outcomes maintained in 10/11 patients at a mean follow-up of 60 months. Recurrence occurred in 3 patients in GN (27.3%), and in 13 out of 44 patients with TN (29.5%). Two patients with recurrent GN underwent successful posterior fossa re-exploration at 41 and 132 months, with complete pain relief. No significant differences in pain outcomes were found between patients with GN and TN (p=0.214), and there was no difference in the rate of complications. CONCLUSION: We suggest MVD as a first-choice procedure for GN leading to satisfactory pain relief with comparable outcomes to MVD for TN. Besides the predominance of arterial conflict, arachnoid adhesions are a shared characteristic in both disorders, highlighting its importance in the pathophysiology of cranial neuralgias.