Staged bilateral microsurgical rhizotomy for treatment of bilateral glossopharyngeal neuralgia: illustrative case
Year: 2025
Type: article
Study design: Case Report
Abstract: BACKGROUND: Glossopharyngeal neuralgia (GPN) is a rare disorder characterized by severe, episodic pain along the sensory distribution of cranial nerve (CN) IX. Bilateral GPN presents unique challenges for consideration of microsurgical treatment due to potential risks of postoperative dysphagia and cardiac arrhythmias associated with resection of bilateral CN IX/X. Here, the authors describe successful staged bilateral microsurgical rhizotomy of CN IX and upper CN X rootlets to treat bilateral GPN. OBSERVATIONS: A 54-year-old female presented with right GPN and underwent a right retrosigmoid craniotomy with rhizotomy, resulting in complete resolution of pain. During the following year, the patient developed left GPN and was considered for the same surgical intervention. However, prior to pursuing surgical intervention, evaluation of her swallowing function was conducted to stratify her risk of pharyngeal sensory denervation or dysphagia, and to confirm her suitability for left-sided rhizotomy. Given the patient's normal oropharyngeal swallowing function on videofluoroscopic swallow study, she underwent left retrosigmoid craniotomy with rhizotomy. At the 3-month follow-up, the patient described complete resolution of pain and normal swallowing function. LESSONS: With the use of comprehensive patient evaluation between surgical stages, staged bilateral microsurgical rhizotomy is a feasible and safe treatment option for carefully selected patients with bilateral GPN. https://thejns.org/doi/10.3171/CASE25359.
DOI: 10.3171/case25359
Institution: Mayo Clinic
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4414686934