Manejo neuroquirúrgico de la neuralgia esencial del nervio glosofaríngeo

Glossopharyngeal neuralgia is a rare entity with an incidence of less than one patient for every 100.000, affecting mostly adults older than 40 years old. The clinic presentation consists of lancinating pain localized in the posterior region of the pharynx; it may be associated to autonomic phenomenon because of the parasympathetic component of the glossopharyngeal nerve. The management of patients with glossopharyngeal neuralgia must be escalated from the initial medical treatment that consists mostly of antiepileptic drugs that have shown variable results. For those cases that show no improvement with medical therapy, surgical treatment must be considered which consists in micro-vascular decompression of the affected nerve; this treatment has shown good outcomes historically. Patients who are not candidates for surgical decompression, percutaneal treatment has shown to be a good alternative with good results in selected patients, even though it has been published that long term outcomes are not as good as those shown with microsurgery. Generally patients with glossopharyngeal neuralgia have good outcomes with proper treatment and selection of patients who undergo surgery.La neuralgia del glosofaríngeo es una patología poco frecuente. La incidencia es menor a uno por cada cien mil habitantes. Su etiología es secundaria a una compresión del nervio por una arteria (arteria vertebral o la ACIP). Produce un dolor lancinante localizado en la región posterior de la faringe y que puede acompañarse de otra sintomatología autonómica por el componente parasimpático del nervio. El tratamiento médico escalona anticonvulsivantes, opioides y medicamentos coadyuvantes. El manejo quirúrgico consiste en la descompresión microvascular que históricamente ha mostrado buenos resultados. Igualmente, el tratamiento percutáneo es de gran utilidad. Por lo general, la neuralgia del glosofaríngeo tiene un buen pronóstico con adecuado manejo y selección de los pacientes para tratamiento quirúrgico o percutáneo