Selective percutaneous thermocoagulation rhizotomy in essential glossopharyngeal neuralgia

Percutaneous radiofrequency (rf) thermocoagulation of the inferior petrous ganglion of Andersch at the jugular foramen has been used to treat three patients with essential glossopharyngeal neuralgia. Two of these patients needed a second rf thermocoagulation, one within 1 week due to an incomplete result, and the other 8 months after the first procedure for recurrence of some neuralgic pain. Thus, a total of five rf thermocoagulations of the ganglion of Andersch have been performed. The patients are now pain-free and without significant side-effects. Deglutition and phonation have remained intact after each rf thermocoagulation. Glossopharyngeal selectivity was obtained by avoiding the risk of injury to the other nerves at the jugular foramen. The surgical technique involves precise x-ray control and constant monitoring of the blood pressure and electrocardiogram findings. Electrode misplacement of any spreading of current to the vagus nerve will be readily detected by bradycardia and hypotension during the physiological testing before a definite rf lesion takes place. This operative technique is described.