Gamma Knife Radiosurgery for Concurrent Trigeminal Neuralgia and Glossopharyngeal Neuralgia

An 82-year-old female had suffered right facial pain since 37 years of her age. The trigeminal neuralgia (TN) was controlled by carbamazepine and peripheral nerve block. The local block was effective for two to three years once performed, and as it became less effective, the patient took carbamazepine. Four months before gamma knife radiosurgery (GKRS), TN worsened. Analysis of her blood sample revealed autoimmune hemolytic anemia. It was suspected to be related to carbamazepine, and the patient stopped taking carbamazepine. The patient suffered pharyngeal pain and had difficulty swallowing for two months before GKRS. Tube feeding was started one month before GKRS. The patient was considered in pain due to TN and glossopharyngeal neuralgia (GPN). We performed GKRS continuously on the right cisternal portion of the trigeminal nerve at a maximum radiosurgical dose of 85 Gy for TN, and on the right cisternal portion of the glossopharyngeal nerve at a maximum dose of 80 Gy for GPN on the same day. The facial pain improved the day after GKRS. Seven days after treatment, the patient could swallow without pharyngeal pain, and the gastric tube was removed. Thirteen months after GKRS, the TN re-occurred but was controlled by carbamazepine 400 mg per day. GPN did not recur at that time. Simultaneous GKRS for concurrent TN and GPN is a less invasive and useful treatment option for non-candidates for surgical interventions.