2026 Poster Presentations
P471: GLOSSOPHARYNGEAL NEURALGIA TREATMENT WITH MICROVASCULAR DECOMPRESSION: A SINGLE-ARM META-ANALYSIS OF PAIN RELIEF DURABILITY AND SIGNALS
Khushal Gupta, MBBS1; Michael Karsy, MD, PhD, MSc, FAANS, FCNS2; 1Bharat Ratna Late Shri Atal Bihari Vajpayee Memorial Medical College; 2University of Michigan Health
Introduction: Glossopharyngeal neuralgia (GPN) is a rare craniofacial pain disorder characterized by sudden, stabbing episodes of throat and ear pain that can be profoundly disabling. For patients who fail medical therapy, microvascular decompression (MVD) offers the only curative option by addressing the underlying neurovascular conflict. Most published experiences of MVD for GPN are small series, and the durability and safety profile remain incompletely understood. We conducted a meta-analysis to evaluate immediate and long-term pain relief, recurrence, and treatment-related mortality following MVD for GPN.
Methods: A systematic search of PubMed, Embase, and Web of Science was performed through August 2025. Eligible studies included cohorts with ≥5 patients undergoing MVD for GPN that reported outcomes on pain relief, recurrence, or complications. The primary endpoints were immediate pain relief, long-term pain relief (last follow-up), recurrence, and perioperative mortality. Random-effects modeling with DerSimonian–Laird estimation was used, and event proportions were stabilized via Freeman–Tukey double arcsine transformation. Between-study heterogeneity was quantified using I² statistics, and prediction intervals were calculated to provide real-world interpretability of pooled outcomes.
Results: A total of 11 studies including 704 patients were analyzed. Across pooled data, the vast majority of patients experienced rapid symptomatic improvement, with an immediate postoperative pain relief rate of 96% (95% CI: 93–99%). Heterogeneity was moderate (I² = 46%). At last follow-up, which varied across series, 92% of patients (95% CI: 86–97%) continued to report durable pain relief. Unlike short-term results, however, heterogeneity was substantially higher (I² = 78%). The pooled recurrence rate was 5% (95% CI: 1–11%), with high heterogeneity (I² = 86%), suggesting that recurrence risk may vary significantly depending on institutional expertise, surgical technique, and duration of surveillance. Mortality after MVD was rare, with a pooled estimate of 3% (95% CI: 1–6%).
Conclusion: This meta-analysis demonstrates that MVD provides both immediate and sustained pain relief for most patients with glossopharyngeal neuralgia, with relatively low recurrence and rare mortality. The results affirm MVD as a safe and effective treatment option, while also underscoring the need for careful long-term follow-up given the variability in recurrence. For patients and clinicians alike, these findings provide reassurance that MVD offers meaningful and lasting benefit in a condition that otherwise profoundly impairs quality of life.
