FACIAL PAIN Treatments of glossopharyngeal neuralgia: towards standard procedures Andrea Franzini 1 • Giuseppe Messina 1 • Angelo Franzini 1 • Marcello Marchetti 2 • Paolo Ferroli 1 • Laura Fariselli 2 • Giovanni Broggi 1 Ó Springer-Verlag Italia 2017 Abstract The degree of disability due to glossopharyngeal neuralgia (GN) refractory to conservative treatments jus- tifies surgical procedures as second-line treatments. Since the first description of this facial pain disorders, many surgical options have been described either via a percuta- neous or an open surgical way. Actually, when a neu- rovascular conflict on root entry zone (REZ) or cisternal portion of the ninth and tenth cranial nerves is identified, microvascular decompression (MVD) is the first surgical option to consider. Many studies have demonstrated its efficacy and safety for the treatment of GN. Recently, stereotactic radiosurgery has gained space in the treatment of selected cases of GN. We provide an overview of the surgical procedures for the treatment of GN and of our own experience. Keywords Glossopharyngeal neuralgia Á Microvascular decompression Á Percutaneous thermorizotomy Á Radiosurgery Introduction First described by Weisenburg in 1910 in a patient with a cerebellopontine angle tumor [1] glossopharyngeal neu- ralgia (GN) is a rare facial pain syndrome which overall incidence is estimated to be between 0.2 and 0.7 per 100,000 individuals per year [2, 3]. It is characterized by severe paroxysmal episodes of electric shock-like lanci- nating pain referred to the external ear canal, the base of the ipsilateral tongue, the tonsil, or the area beneath the angle of the jaw. Pain usually starts in the region of the ear, and then irradiates to the ipsilateral throat region or vice versa; it is triggered by yawning, swallowing, talking, and coughing. It may be accompanied by severe cardiovascular issues, such as life-threatening syncopal episodes, hypotension, bradycardia, or even asystole due to the concomitant involvement of the vagal nerve (which sup- plies the carotid sinus [4, 5]). The majority of GN patients have no underlying cause or associated neurological deficit and the syndrome in this case is termed ‘‘classic’’ or idiopathic, while a smaller group is ‘‘symptomatic’’, due to the presence of a structural lesion affecting the distribution of the ninth and tenth cranial nerves [6]. Since the first attempts of sectioning the glossopharyn- geal nerve extracranially by Sicard and Rubineau in 1920 [7], many different pharmacological and surgical treatment modalities have been applied to treat GN. In particular, surgery should be considered when a situation of drug intolerance or refractoriness develops [8, 9]. & Andrea Franzini andrea.franzini1@hotmail.it Giuseppe Messina Giusmex@gmail.com Angelo Franzini bsvjf@tin.it Marcello Marchetti marcello.marchetti@istituto-besta.it Paolo Ferroli pferroli@istituto-besta.it Laura Fariselli lfariselli@istituto-besta.it Giovanni Broggi gbroggi@gmail.com 1 Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy 2 Radiosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy 123 Neurol Sci (2017) 38 (Suppl 1):S51–S55 DOI 10.1007/s10072-017-2909-6