Radiosurgery for Glossopharyngeal Neuralgia: A Systematic Review and Meta-Analysis

Glossopharyngeal neuralgia (GPN) is a rare craniofacial pain disorder accounting for 1% of all craniofacial pain syndromes. Pharmacological agents are the first-line option for GPNs, but failure occurs in up to 50% of the cases. Microvascular decompression (MVD), rhizotomy (RHZ), and stereotactic radiosurgery (SRS) are the 3 main options for GPNs. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of SRS in patients with GPNs.

A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science on February 20, 2025. Studies that reported pain-related outcomes were included. The Barrow Neurological Institute (BNI) considered a completely pain-free status, and BNI I-IIIb was deemed acceptable for pain relief. The short-term was considered the first post-SRS follow-up, and the long-term was defined as the last follow-up.

Six studies with 75 GPN patients were included. The meta-analysis revealed a pooled rate of short-term complete and acceptable pain relief of 44% (95% CI: 32%-56%) and 86% (95% CI: 76%-94%), respectively. The meta-analysis indicated a pooled rate of long-term complete and acceptable pain relief of 46% (95% CI: 34%-59%) and 79% (95% CI: 49%-98%), respectively. Additionally, the meta-analysis showed a pooled adverse radiation effect (ARE) rate of 1% (95% CI: 0%-6%) and a recurrence rate of 39% (95% CI: 27%51%).

SRS is an efficient and safe alternative for GPNs, with promising pain-related outcomes and minimal likelihood of complications, especially in high-risk patients for invasive surgical interventions.