Gamma Knife Radiosurgery for Glossopharyngeal Neuralgia by Targeting the Medial Cisternal Segment of the Glossopharyngeal Nerve: Report of 3 Cases

Gamma knife surgery (GKS) is now used as a treatment option for glossopharyngeal neuralgia (GPN). Most authors have selected the distal part of the nerve as the gamma knife target. Here we report on 3 patients with medically intractable GPN who were treated with GKS. All 3 patients had a single shot with a 4-mm collimator which was used to deliver 80 Gy to the 100% isodose line. The GKS targets were the medial cisternal segments of the glossopharyngeal nerve. Patients were investigated prospectively, treated, and then assessed periodically with respect to pain relief and neurological function. Three patients felt pain reduced at 2, 7, and 11 days, respectively. None of them have suffered recurrent pain since becoming pain free. The follow-up after radiosurgery was 25 months, 22 months, and 20 months, respectively. This preliminary experience provides encouraging evidence that choosing the medial cisternal segment of the glossopharyngeal nerve as the target is also an option for the treatment of GPN with stereotactic radiosurgery and is consistent with previous reports. Additional follow-ups and a larger number of patients are needed to demonstrate the long-term safety and effectiveness for this indication.