Y. Kanpolat et al., COMPUTED TOMOGRAPHY-GUIDED TRIGEMINAL TRACTOTOMY-NUCLEOTOMY IN THE MANAGEMENT OF VAGOGLOSSOPHARYNGEAL AND GENICULATE NEURALGIAS, Neurosurgery, 43(3), 1998, pp. 484-489
OBJECTIVE: Vagoglossopharyngeal and geniculate neuralgias are less fre
quently seen types of cranial neuralgias. Their causes and symptomatol
ogy are similar to those of trigeminal neuralgia; however, the complex
anatomic relationship between the intermedius, vagal, and glossophary
ngeal nerves leads to difficulties in the diagnosis and management of
neuralgias originating from these cranial nerves. Numerous procedures
have been used to treat intractable neuralgias of the VIIth, IXth, and
Xth cranial nerves: 1) extracranial sectioning of the cranial nerves,
2) percutaneous thermal rhizotomy, 3) intracranial glossopharyngeal a
nd vagal rhizotomies, 4) microvascular decompression, and 5) percutane
ous trigeminal tractotomy-nucleotomy (TR-NC) or nucleus caudalis dorsa
l root entry zone operation. We propose that computer-guided TR-NC may
be the first-choice operation for patients with glossopharyngeal, vag
al, or geniculate neuralgia. PATIENTS AND METHODS: Nine patients suffe
ring from idiopathic vagoglossopharyngeal neuralgia (six patients) and
geniculate neuralgia (three patients) were managed at our clinic. Com
puted tomography-guided percutaneous trigeminal TR-NC was performed fo
r these nine patients. RESULTS: Excellent (six patients) or good (thre
e patients) pain control was obtained in each patient. Complications i
ncluded temporary ataxia in two patients after TR-NC. CONCLUSION: The
risk:benefit ratio should be evaluated individually to select the appr
opriate treatment procedure for patients with vagoglossopharyngeal and
geniculate neuralgias. Computed tomography-guided percutaneous TR-NC
is an effective and minimally invasive procedure for such patients.