Repeat Gamma-Knife Radiosurgery for Recurrent Glossopharyngeal Neuralgia: Case Report and Literature Review

Glossopharyngeal neuralgia (GPN) is a rare facial pain syndrome, but its symptoms are debilitating. For medication-resistant idiopathic GPN, stereotactic radiosurgery (SRS) is an emerging treatment option with a promising role; however, recurrence after SRS is not uncommon. SRS for recurrent GPN is rarely reported. We present a patient who underwent repeat SRS for recurrent GPN and subsequently maintained over 3 years of complete pain relief. A review of literature of recurrent GPN treated with repeat SRS revealed only 9 previous cases. Six patients (66.7%) had adequate pain relief at 12 months. Four patient (44%) had adequate pain relief at their last follow-up at a median of 24.5 months. Four patients (44%) had recurrence at a median of 25 months. Only two patients (22%) experienced mild adverse radiation effects. Repeat SRS is a viable and minimally invasive alternative to open surgery for the treatment of recurrent GPN; however, it may be associated with a low risk of adverse radiation effects. Limited by the small cohort of patients, response to initial SRS of >5 months, maximum doses greater than 75 Gy, and a target at the glossopharyngeal meatus provide the best predictors for an effective second treatment.

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