Medications used for
trigeminal neuralgia can sometimes control GPN pain. Surgical interventions
are considered when the pain becomes severe and medical therapy does
not provide adequate pain relief or causes unacceptable side effects.
A rhizotomy procedure involves sectioning of the glossopharyngeal
nerve and upper rootlets of the vagus nerve. This effectively relieves
the pain for the majority of sufferers, but may however, cause swallowing
problems due to the nerve injury. The rhizotomy is usually performed
with open surgery similar to Microvascular decompression surgery.
Microvascular decompression surgery for GPN relieve the compression
of blood vessels upon the IXth and Xth cranial nerve rootlets emerging
from the lateral medulla. This surgery does not injure the nerves, and
cures GPN in about three-quatres of patients. Compared to rhizotomy
procedures, the recurrence of GPN is less likely following MVD.
Percutaneous
radiofrequency rhizotomy for GPN is performed with a needle advanced
through the cheek to the skull base, directed to produce injury of the
IX and X cranial nerves. This procedure involves a higher risk of producing
numbness and swallowing difficulties. However, it is well-suited for
treatment of secondary GPN, when the tumor has already damaged the nerve
function. In such cases, treatment of the tumor itself may reduce the
GPN pain. Percutaneous radiofrequency rhizotomy is also an option for
sufferers who are not candidates for other more invasive surgical procedures.
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