Internal Neurolysis for Glossopharyngeal Neuralgia without Vascular Compression: Report of 2 Cases.

Internal neurolysis has been shown to be effective in treating trigeminal neuralgia without vascular compression. However, its use in glossopharyngeal neuralgia has been rarely reported, with only a single previous case described in the literature, despite the similarities in the underlying mechanisms of neurovascular compression. This study reports 2 cases of glossopharyngeal neuralgia without vascular compression that were successfully treated with internal neurolysis. Patient 1, a 57-year-old woman with 32 months of untreated episodic pain, underwent microvascular decompression, but no vascular compression was identified. Internal neurolysis was performed, generating immediate pain relief and resolution of transient dysphagia and hoarseness within days. The patient remained pain-free at 18-month follow-up. Patient 2, a 65-year-old man with recurrent pain after prior microvascular decompression and gamma knife radiosurgery, underwent a second microvascular decompression, which failed to resolve his symptoms. Internal neurolysis was performed 21 months later, leading to sustained pain relief and no recurrence at 12-month follow-up. These cases suggest that internal neurolysis is a feasible and potentially effective treatment for glossopharyngeal neuralgia without vascular compression. However, the procedure presents technical challenges due to the fragile and mobile nature of the glossopharyngeal nerve, necessitating meticulous handling and precise dissection to avoid nerve injury. Further studies are required to evaluate its long-term efficacy and safety.