Treatment of Glossopharyngeal Neuralgia: A Systematic Review

Glossopharyngeal neuralgia (GPN) is a rare neuropathy characterized by paroxysmal, unilateral, and severe pain episodes affecting the throat, tonsils, base of the tongue, and pharynx. Its management remains challenging due to the absence of standardized treatment protocols and the limited availability of high-quality comparative studies.

To review and compare the effectiveness and safety of available treatments for GPN.

A systematic review was conducted, analyzing studies published in the last decade that evaluated GPN treatments. Searches were performed in PubMed, SCIELO, and the Regional Portal of BVS. Studies were assessed for quality, risk of bias, and key outcomes, including pain relief and adverse effects.

Twenty-six studies, comprising 973 patients, were included. Seven treatment modalities were analyzed. Microvascular decompression (MVD) demonstrated the highest efficacy and durability, with an immediate pain relief rate exceeding 86.7% and exhibiting the lowest recurrence rates. Alternative treatments, including gamma knife radiosurgery, radiofrequency thermocoagulation, and pulsed radiofrequency, showed initial pain relief but had higher recurrence rates over time. The posterior inferior cerebellar artery was the most frequently involved vessel in cases with vascular compression.

MVD is the preferred first-line surgical treatment when pharmacological therapy fails, vascular compression is present, and the patient is a suitable candidate for surgery. In cases where MVD is contraindicated or vascular compression is absent, alternative treatments should be considered based on individual patient factors, balancing efficacy and long-term outcomes. Further high-quality studies are needed to refine treatment strategies for GPN.