舌咽神経痛と三叉神経痛が同時に認められた1例

A Case of Combined Glossopharyngeal and Trigeminal Neuralgia

Ⅰ．はじめに

　特発性の三叉神経痛，顔面痙攣，舌咽神経痛の原因が，主に血管による神経圧迫にあることは，今や広く知られている．機能的な疾患であり，薬物を中心とした内科的な治療が第一選択であるが，症例によっては，外科的に微小血管減圧術（microvascular decompression：MVD）が選択される．これらのいわゆる神経血管圧迫症候群の中で，舌咽神経痛は稀な疾患であり，三叉神経痛との合併例はさらに稀である．われわれは，この稀な合併例を経験したが，multi-volume法により，術前に両神経の状態を把握することができた．若干の文献的考察を加え，報告する．

　It is well-known that idiopathic neuralgias of the trigeminal and glossopharyngeal nerves are caused by vascular compression at the root entry zone of the cranial nerves. Because they are functional diseases,initial treatment is medical,especially with carbamazepine. However,if medical therapy fails to adequately manage the pain,microvascular decompression (MVD) is prescribed. Glossopharyngeal neuralgia is rare,and combined trigeminal and glossopharyngeal neuralgia is an extremely rare disorder. A 70-year-old woman presented herself to Hokkaido Neurosurgical Memorial Hospital because of paroxysms of lancinating pain in her left pharynx and another lancinating pain in her left cheek. Carbamazepine,which was prescribed at another hospital,favorably relieved the pain; however,drug eruption compelled her to discontinue the medication.

　The multi-volume method revealed that a root entry zone of the left glossopharyngeal nerve was compressed by the left posterior inferior cerebellar artery, and the left trigeminal artery was compressed by the left superior cerebellar artery. MVD for both nerves was performed employing a left lateral suboccipital craniotomy. She experienced complete relief of pain immediately after MVD.

　Combined trigeminal and glossopharyngeal neuralgia is extremely rare,but some groups noted a relatively high incidence of concurrent trigeminal neuralgia in patients with glossopharyngeal neuralgia up until the 1970's. Glossopharyngeal neuralgia includes pain near the gonion; therefore,there is an overlap of symptoms between glossopharyngeal and trigeminal neuralgias. By virtue of recent progress in imaging technology,minute preoperative evaluations of microvascular compression are possible. Until the 1970's,there might have been some misunderstanding regarding the overlap of symptoms because of lack of the concept of microvascular compression as a cause of neuralgia and rudimentary imaging technology. Minute evaluations of both symptoms and imaging are very important.