COMPUTED TOMOGRAPHY-GUIDED TRIGEMINAL TRACTOTOMY-NUCLEOTOMY IN THE MANAGEMENT OF VAGOGLOSSOPHARYNGEAL AND GENICULATE NEURALGIAS

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.