Long-term outcomes after microvascular decompression for glossopharyngeal neuralgia

Long-term data on outcomes following microvascular decompression (MVD) without neurectomy for glossopharyngeal neuralgia (GPN), specifically focusing on pain location, are sparse. The aim of this study was to investigate the long-term efficacy and safety of MVD without neurectomy for GPN with particular emphasis on redo MVD and pain location. Consecutive patients who underwent MVD for classical GPN performed by the senior author from 2013 to 2021 were included in this retrospective cohort study. Medical records were reviewed, and clinical and telemedicine follow-up were analyzed to assess outcomes. Among 29 patients (18 male, median age at surgery 65.0 years) included in the analysis, 38% had throat pain radiating to the ear and 35% had throat pain only. Eleven patients (38%) had previously undergone other unsuccessful procedures. After MVD, 83% of patients were immediately pain free and 10% experienced partial pain relief. The mean follow-up duration was 65.3 months. At the final follow-up, 86% of patients were completely pain free and 11% had partial pain relief. Three patients each (10% and 11%) experienced immediate and long-term complications, respectively. Redo MVD completely relieved pain in 3 of 4 patients. These findings support the use of MVD without neurectomy in patients with classical GPN, including redo MVD in patients with persistent neurovascular compression. The direction of symptom radiation was not associated with pain outcomes.