Nevralgia vagoglossofaríngea

Rossitti, S. L.; Balbo, R.J.; Sperlescu, A.

doi:10.1590/S0004-282X1991000100011

Resumos

Revisão dos conceitos vigentes sobre a clínica, patogenia, diagnóstico diferencial e tratamento da neuralgia vagoglossofaríngea, e relato de três casos operados por neurotomia intracraniana do n. IX e n. X (parcial). A anatomia da inervação sensitiva das regiões profundas da face e transição cervicofacial, com suas implicações clínicas, e a teoria da compressão neurovascular na patogenia das disfunções ditas «hiperativas» dos nervos cranianos, são comentadas criticamente.

Review of current opinions concerning clinical presentation, etiology, differential diagnosis and management of vagoglossopharyngeal neuralgia. Three cases are reported, treated by intracranial section of n. IX (alone in one case) and upper rootlets of n. X. In two patients no vascular compression of the nerves was observed. In one case an atheromatous elongated basilar artery was observed compressing and deforming the medulla oblonga at the entry zone of nerves IX-X. In this case, pain paroxysms recurred, some weeks after surgery, and the patient underwent re-operation (microvascular decompression of the medulla) with good outcome. Clinical implications of the complex sensitive innervation of profound regions of the face and cervicofacial region are emphasized. Certain circumstances, such as gustatory pain due to sympathetic denervation of parotid gland, the neck-tongue syndrome and oropharyngeal pain by irritation of the first cervical spinal nerve (during lateral suboccipital puncture), point to the fact that in this region similar symptoms may be provoked by mechanisms involving different peripheric pain pathways. The theory of microvascular compression in the pathogeny of cranial nerve «hyperactive» dysfunctions is critically commented.

CONTENTS CONTEÚDO

S. L. Rossitti^I; R.J. Balbo^II; A. Sperlescu^III

^IMédico Residente - Departamento de Neuro-Psiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas (PUCCAMP) e Departamento de Neurocirurgia do Hospital Vera Cruz (HVC), Campinas

^IIProfessor Adjunto e Diretor do Departamento de Neurocirurgia do HVC - Departamento de Neuro-Psiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas (PUCCAMP) e Departamento de Neurocirurgia do Hospital Vera Cruz (HVC), Campinas

^IIIProfessor Assistente e Neurocirurgião do HVC - Departamento de Neuro-Psiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas (PUCCAMP) e Departamento de Neurocirurgia do Hospital Vera Cruz (HVC), Campinas

RESUMO

Revisão dos conceitos vigentes sobre a clínica, patogenia, diagnóstico diferencial e tratamento da neuralgia vagoglossofaríngea, e relato de três casos operados por neurotomia intracraniana do n. IX e n. X (parcial). A anatomia da inervação sensitiva das regiões profundas da face e transição cervicofacial, com suas implicações clínicas, e a teoria da compressão neurovascular na patogenia das disfunções ditas «hiperativas» dos nervos cranianos, são comentadas criticamente.

SUMMARY

Review of current opinions concerning clinical presentation, etiology, differential diagnosis and management of vagoglossopharyngeal neuralgia. Three cases are reported, treated by intracranial section of n. IX (alone in one case) and upper rootlets of n. X. In two patients no vascular compression of the nerves was observed. In one case an atheromatous elongated basilar artery was observed compressing and deforming the medulla oblonga at the entry zone of nerves IX-X. In this case, pain paroxysms recurred, some weeks after surgery, and the patient underwent re-operation (microvascular decompression of the medulla) with good outcome. Clinical implications of the complex sensitive innervation of profound regions of the face and cervicofacial region are emphasized. Certain circumstances, such as gustatory pain due to sympathetic denervation of parotid gland, the neck-tongue syndrome and oropharyngeal pain by irritation of the first cervical spinal nerve (during lateral suboccipital puncture), point to the fact that in this region similar symptoms may be provoked by mechanisms involving different peripheric pain pathways. The theory of microvascular compression in the pathogeny of cranial nerve «hyperactive» dysfunctions is critically commented.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Dr. Sandro L. Rossitti - Departamento de Neurocirurgia, Hospital Vera Cruz - Av. Andrade Neves 402 - 13020 Campinas SP - Brasil.

1. Adams CBT. Microvascular compression : an alternative view and hypothesis. J Neurosurg 1989, 70:1.
2. Alonso T, Pujol J, Ayuso A, Pujol J. Sustained hypertension after section of the glossopharyngeal nerve. J Neurol Neurosurg Psychiat 1981, 44 : 369.
3. Bogduk N. An (anatomical basis for the neck-tongue syndrome. J Neurol Neurosurg Psychiat 1981, 44:202.
4. Dandy WE. Glossopharyngeal neuralgia (tic douloureux) : its diagnosis and treatment. Arch Surg 1927, 15 : 198.
5. Freystadtl B. Kehlkopf und Rachen in ihren Beziehungen zu den Erkrankungen des Zentralnervensystems. Berlin: Karger, 1928, p 45.
6. Jannetta PJ. Neurovascular compression in cranial nerve and systemic disease. Ann Surg 1980, 192-518.
6Ş Janetta PJ Cranial rhizopathies. In Youmans JR (ed) : Neurological Surgery, vol 6. Ed 3. Philadelphia: Saunders, 1990, p 4169.
7. Kempe LG, Smith DR. Trigeminal neuralgia, facial spasm, intermedius and glossopharyngeal neuralgia with persistent carotid-basilar anastomosis. J Neurosurg 1969, 31:445.
8. Lance JW, Anthony M. Neck-tongue syndrome on sudden turning of the head. J Neurol Neurosurg Psychiat 1980, 43:97.
9. Lang J, Reiter U. Ueber die intrazisternale Länge der Hirnnerven VII-XII. Neuro-chirurgia (Stuttgart) 1985, 28:153.
10. Laskiewicz A. Anatomical and clinical considerations on some rare forms of glossopharyngeal neuralgias. Acta Oto-Laryngol 1953, 43:545.
11. Lazorthes G. Le Systeme Nerveux Périphérique. Paris : Masson, 1955, p 127 (n. IX), p 139 (n. X).
12. Lazorthes Y, Verdie JC. Radiofrequency coagulation of the petrous ganglion in glossopharyngeal neuralgia. Neurosurgery 1979, 4:512.
13. Leriche R. La Philosophie de la Chirurgie. Paris : Flammarion, 1951, p 16.
14. Mracek Z. Compression of the spinal trigeminal tract due to pressure of the inferior posterior cerebellar artery as the causative factor of facial neuralgia (Cze). Rozhledy v chirurgii 1982, 61:116.
15. Rossitti SL, Araújo JFM, Zuiani AR, Balbo RJ. Dor faríngea durante punção suboccipital lateral. Arq Neuro-Psiquiat (São Paulo) 1989, 47:182.
16. Tew JM Jr. Percutaneous rhizotomy in the treatment of intractable facial pain (trigeminal, glossopharyngeal and vagal nerves). In Schmidek HH, Sweet WH (eds) : Current Techniques in Operative Neurosurgery. New York: Grune & Stratton, 1977, p 409.
17. Truax BT. Gustatory pain: a complication of carotid endarterectomy.' Neurology 1989, 39:1258.
18. White JC, Sweet WH. Pain and the Neurosurgeon : A Forty-Year Experience. Springfield : Charles C. Thomas, 1969, p 257.

Nevralgia vagoglossofaríngea

Vagoglossopharyngeal neuralgia.

Datas de Publicação

Publicação nesta coleção
22 Fev 2011
Data do Fascículo
Mar 1991

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Adams CBT. Microvascular compression : an alternative view and hypothesis. J Neurosurg 1989, 70:1.

[2] 2. Alonso T, Pujol J, Ayuso A, Pujol J. Sustained hypertension after section of the glossopharyngeal nerve. J Neurol Neurosurg Psychiat 1981, 44 : 369.

[3] 3. Bogduk N. An (anatomical basis for the neck-tongue syndrome. J Neurol Neurosurg Psychiat 1981, 44:202.

[4] 4. Dandy WE. Glossopharyngeal neuralgia (tic douloureux) : its diagnosis and treatment. Arch Surg 1927, 15 : 198.

[5] 5. Freystadtl B. Kehlkopf und Rachen in ihren Beziehungen zu den Erkrankungen des Zentralnervensystems. Berlin: Karger, 1928, p 45.

[6] 6. Jannetta PJ. Neurovascular compression in cranial nerve and systemic disease. Ann Surg 1980, 192-518.

[7] 6Ş Janetta PJ Cranial rhizopathies. In Youmans JR (ed) : Neurological Surgery, vol 6. Ed 3. Philadelphia: Saunders, 1990, p 4169.

[8] 7. Kempe LG, Smith DR. Trigeminal neuralgia, facial spasm, intermedius and glossopharyngeal neuralgia with persistent carotid-basilar anastomosis. J Neurosurg 1969, 31:445.

[9] 8. Lance JW, Anthony M. Neck-tongue syndrome on sudden turning of the head. J Neurol Neurosurg Psychiat 1980, 43:97.

[10] 9. Lang J, Reiter U. Ueber die intrazisternale Länge der Hirnnerven VII-XII. Neuro-chirurgia (Stuttgart) 1985, 28:153.

[11] 10. Laskiewicz A. Anatomical and clinical considerations on some rare forms of glossopharyngeal neuralgias. Acta Oto-Laryngol 1953, 43:545.

[12] 11. Lazorthes G. Le Systeme Nerveux Périphérique. Paris : Masson, 1955, p 127 (n. IX), p 139 (n. X).

[13] 12. Lazorthes Y, Verdie JC. Radiofrequency coagulation of the petrous ganglion in glossopharyngeal neuralgia. Neurosurgery 1979, 4:512.

[14] 13. Leriche R. La Philosophie de la Chirurgie. Paris : Flammarion, 1951, p 16.

[15] 14. Mracek Z. Compression of the spinal trigeminal tract due to pressure of the inferior posterior cerebellar artery as the causative factor of facial neuralgia (Cze). Rozhledy v chirurgii 1982, 61:116.

[16] 15. Rossitti SL, Araújo JFM, Zuiani AR, Balbo RJ. Dor faríngea durante punção suboccipital lateral. Arq Neuro-Psiquiat (São Paulo) 1989, 47:182.

[17] 16. Tew JM Jr. Percutaneous rhizotomy in the treatment of intractable facial pain (trigeminal, glossopharyngeal and vagal nerves). In Schmidek HH, Sweet WH (eds) : Current Techniques in Operative Neurosurgery. New York: Grune & Stratton, 1977, p 409.

[18] 17. Truax BT. Gustatory pain: a complication of carotid endarterectomy.' Neurology 1989, 39:1258.

[19] 18. White JC, Sweet WH. Pain and the Neurosurgeon : A Forty-Year Experience. Springfield : Charles C. Thomas, 1969, p 257.