Microvascular decompression for glossopharyngeal neuralgia using the transcondylar fossa approach: long-term follow-up results

The authors of this retrospective study evaluated the long-term surgical outcomes and complications of microvascular decompression (MVD) for glossopharyngeal neuralgia (GPN) using the combined transcondylar fossa (trans-CF) and unilateral transcerebellomedullary fissure (trans-CMF) approach. All patients with idiopathic GPN treated via MVD at the authors' institution from 2003 to 2019 were considered for study inclusion. The combined trans-CF and unilateral trans-CMF approach was utilized with particular attention to securing the offending vessel(s) to the dura mater to prevent recurrence. Surgical outcomes were evaluated using the Barrow Neurological Institute (BNI) pain intensity scale. Of the 23 patients treated with MVD via the combined trans-CF and unilateral trans-CMF approach in the study period, 21 (14 females 66.7% and 7 males 33.3%, mean age 60.6 years) were followed up for more than 5 years (mean 149.9 months, range 63-235 months). Twenty (95.2%) of the 21 patients reported immediate pain relief (BNI pain score I), and only one required reoperation for recurrent pain. At the final follow-up, the 20 patients without reoperation reported complete pain relief and no increase in their BNI pain score (indicating greater pain). Seven patients (33.3%) experienced transient mild dysphagia or hoarseness postsurgery, but there were no permanent complications. MVD for GPN using the combined trans-CF and unilateral trans-CMF approach achieved excellent outcomes with few complications. This technique offers several advantages: 1) wider exposure of the lower cerebellopontine angle, 2) reduced cerebellar retraction, 3) improved visualization for transposition of offending vessels, particularly a high-origin posterior inferior cerebellar artery, and 4) minimal manipulation of the lower cranial nerves. The selection of a suitable approach based on careful preoperative imaging and appropriate vessel transposition techniques is essential for achieving favorable long-term outcomes.