P-006 - (Poster #6) Pulsed Radiofrequency Ablation in the Treatment of Symptomatic Glossopharyngeal Neuralgia

Background: Glossopharyngeal neuralgia (GPN) is a rare craniofacial pain disorder characterized by sudden, severe, stabbing pain in the areas innervated by the glossopharyngeal nerve, including the throat, tonsils, posterior tongue, and ear. Pain is typically triggered by activities such as swallowing, speaking, or coughing. GPN affects approximately 0.2 to 0.7 per 100,000 people annually, making it far less common than trigeminal neuralgia. It usually presents in middle-aged to older adults with a male predominance. Causes include neurovascular compression, tumors, infections, or prior surgeries, though many cases are idiopathic. Diagnosis is primarily clinical after imaging has been used to rule out secondary causes. GPN significantly impacts quality of life. Treatment options range from pharmacologic therapies such as carbamazepine, to interventional procedures like nerve blocks, radiofrequency ablation, and microvascular decompression.

Purpose/Objectives: Treatment of Glossopharyngeal Neuralgia is clinically complicated, with commonly used medications having occasionally significant side effects.  Interventional treatments are less commonly utilized as the highly vascular anatomy may represent increased risks.  We describe the successful use of pulsed radiofrequency ablation using the styloid process as a bony landmark for fluoroscopically guided intervention.

Methods: Our patient had presented to clinic with reports of painful Glossopharyngeal Neuralgia affecting quality of life.  Medical management did not provide sufficient relief.  Efficacy of treatment was assessed using patient self report.  As this was a case report, statistical methods were not employed as the purpose of this abstract is to prompt further study with larger patient sample size.

Results: Our patient reported roughly five months of improvement in symptoms, including decrease odynophagia, glossalgia, and 'stupor of thought.'  No complications were encountered with the procedure, and the patient has since requested repeat.  Pulsed radiofrequency ablation represents a relatively infrequently utilized treatment option for Glossopharyngeal Neuralgia for a variety of reasons, and the aim of this report is to highlight the relative safety and efficacy of this procedure in a patient that was minimally responsive to prior treatment options.  We will provide a brief anatomic review and brief discussion of potential risks with this intervention.

Conclusions/Implications for future research and/or clinical care: Painful Glossopharyngeal Neuralgia is an understudied condition, likely due to the relatively low prevalence.  Nevertheless, patients affected by this report significant decreases in quality of life measures.  Additional treatment options for rare conditions deserve increased attention and, where possible, formal study which can be complicated by the low prevalence.  We present a case of successful treatment of medication refractory Glossopharyngeal Neuralgia as a case report on a potential additional treatment for healthcare providers to consider with their patients and potential future study design.