Glossopharyngeal Neuralgia/Neuropathy with Hemodynamic Instability and Associated Syncope Treated with Stereotactic Radiosurgery

Christopher Banerjee, Angela Viers, John Vender

Research output: Contribution to journalArticle

Abstract

Background: Glossopharyngeal neuralgia/neuropathy is rare, and less than 3% of cases involve cardiac arrhythmias of syncope due to activated vagal reflex pathways. Most of these cases are successfully treated with medical management with or without pacemaker placement. We present the first reported case of glossopharyngeal neuralgia/neuropathy with cardiac symptoms refractory to medical management including pacemaker placement but successfully treated with Gamma Knife Radiosurgery. Case Description: A 70-year-old Caucasian man with recurrent squamous cell carcinoma of the tongue base treated with multiple surgeries, lymph node excision, chemotherapy, and external beam radiation, developed episodes of severe right ear and throat pain. These episodes would be followed by syncopal episodes associated with hypotension and bradycardia. Aggressive medical management including pacemaker could not stabilize the patient's hemodynamic instability. After extensive workup, the patient was diagnosed with glossopharyngeal neuralgia/neuropathy with associated carotid sinus instability. The patient was not a strong surgical candidate, thus the patient underwent Gamma Knife Radiosurgery. The target was set as the glossopharyngeal meatus. Within days of treatment, the patient had no further clinically significant syncope or hemodynamic instability for the remaining 6 months of his life. Conclusions: To our knowledge, we present the first case of glossopharyngeal neuralgia/neuropathy with medically refractory cardiac dysfunction successfully treated with Gamma Knife Radiosurgery. We advocate that Gamma Knife be considered for similar subsets of patients.

Original languageEnglish (US)
Pages (from-to)314-317
Number of pages4
JournalWorld Neurosurgery
Volume139
DOIs
StatePublished - Jul 2020

Keywords

  • Gamma Knife
  • Glossopharyngeal
  • Neuralgia
  • Neuropathy
  • Radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Glossopharyngeal Neuralgia/Neuropathy with Hemodynamic Instability and Associated Syncope Treated with Stereotactic Radiosurgery'. Together they form a unique fingerprint.

  • Cite this