Glossopharyngeal and Limited Vagal Neurectomy for Cancer-related Carotid Sinus Syncope

Overview

Journal Skull Base

Date 2010 Mar 2

PMID 20190949

Citations 2

Authors

Harrison W Lin

Michael B Rho

Sepideh Amin-Hanjani

Fred G Barker

Daniel G Deschler

Affiliations

Soon will be listed here.

Abstract

Head and neck cancer patients with cervical disease involving the glossopharyngeal or vagus nerves can experience dangerous cardiovascular phenomena, including carotid sinus syncope (CSS). Medical and minimally invasive interventions, including pacemaker placement, incompletely address the etiologies of syncopal episodes and therefore often provide limited benefit. The objectives of this report are to highlight the difficulties of managing cancer-related CSS, to present a highly effective surgical intervention, and to review the literature regarding the pathophysiology and treatment options for patients with cancer-related CSS. Two patients with cancer-related CSS continued to experience syncopal episodes despite medical and pacemaker therapy. Consequently, these patients underwent a suboccipital craniotomy for glossopharyngeal and limited vagal neurectomy. After surgery, both patients had uncomplicated postoperative courses with resolution of syncope.

Citing Articles

Severe hypotension requiring resuscitation in tumour-related carotid sinus syndrome: a case report.

Klingenberg M, Sinkeler S, Koopmans N, Plaat R Eur Heart J Case Rep. 2024; 8(8):ytae393.

PMID: 39184171 PMC: 11342958. DOI: 10.1093/ehjcr/ytae393.

Treatment of syncope in tongue cancer with palliative chemotherapy in the intensive care unit: A case report.

Fang C, Yang L, Zeng G, Huang R, Fang W, Chen Y Medicine (Baltimore). 2019; 98(35):e16998.

PMID: 31464952 PMC: 6736034. DOI: 10.1097/MD.0000000000016998.

References

Muntz H, Smith P . Carotid sinus hypersensitivity: a cause of syncope in patients with tumors of the head and neck. Laryngoscope. 1983; 93(10):1290-3. DOI: 10.1002/lary.1983.93.10.1290. View

Barbash G, Keren G, Korczyn A, Sharpless N, CHAYEN M, Copperman Y . Mechanisms of syncope in glossopharyngeal neuralgia. Electroencephalogr Clin Neurophysiol. 1986; 63(3):231-5. DOI: 10.1016/0013-4694(86)90089-1. View

Taha J, TEW Jr J . Long-term results of surgical treatment of idiopathic neuralgias of the glossopharyngeal and vagal nerves. Neurosurgery. 1995; 36(5):926-30; discussion 930-1. DOI: 10.1227/00006123-199505000-00006. View

Taylor P, Gray K, Bicknell P, Rees J . Glossopharyngeal neuralgia with syncope. J Laryngol Otol. 1977; 91(10):859-68. DOI: 10.1017/s0022215100084486. View

Roa N, Krupin B . Glossopharyngeal neuralgia with syncope--anesthetic considerations. Anesthesiology. 1981; 54(5):426-8. DOI: 10.1097/00000542-198105000-00017. View

Sobol S, Wood B, Conoyer J . Glossopharyngeal neuralgia-asystole syndrome secondary to parapharyngeal space lesions. Otolaryngol Head Neck Surg. 1982; 90(1):16-9. DOI: 10.1177/019459988209000104. View

Dykman T, Montgomery Jr E, Gerstenberger P, Zeiger H, Clutter W, Cryer P . Glossopharyngeal neuralgia with syncope secondary to tumor. Treatment and pathophysiology. Am J Med. 1981; 71(1):165-70. DOI: 10.1016/0002-9343(81)90287-4. View

Worth P, Stevens J, Lasri F, Brew S, Reilly M, Mathias C . Syncope associated with pain as the presenting feature of neck malignancy: failure of cardiac pacemaker to prevent attacks in two cases. J Neurol Neurosurg Psychiatry. 2005; 76(9):1301-3. PMC: 1739799. DOI: 10.1136/jnnp.2004.054510. View

Ishii T . Glossopharyngeal neuralgia: surgical treatment and electron microscopic findings. Laryngoscope. 1976; 86(4):577-83. DOI: 10.1288/00005537-197604000-00015. View

10.

Torigoe T, Kato I, Suzuki T, KENMOCHI M, TAKEYAMA I . Two cases with glossopharyngeal neuralgia treated by nerve reaction: oropharyngeal approach. Acta Otolaryngol Suppl. 1996; 522:142-5. View

11.

Ferrante L, Artico M, Nardacci B, Fraioli B, Cosentino F, Fortuna A . Glossopharyngeal neuralgia with cardiac syncope. Neurosurgery. 1995; 36(1):58-63; discussion 63. DOI: 10.1227/00006123-199501000-00007. View

12.

Resnick D, Jannetta P, Bissonnette D, Jho H, Lanzino G . Microvascular decompression for glossopharyngeal neuralgia. Neurosurgery. 1995; 36(1):64-8; discussion 68-9. DOI: 10.1227/00006123-199501000-00008. View

13.

Patel A, Yap V, Fields J, Thomsen J . Carotid sinus syncope induced by malignant tumors in the neck. Emergence of vasodepressor manifestations following pacemaker therapy. Arch Intern Med. 1979; 139(11):1281-4. View

14.

Macdonald D, Strong E, Nielsen S, Posner J . Syncope from head and neck cancer. J Neurooncol. 1983; 1(3):257-67. DOI: 10.1007/BF00165610. View

15.

Frank J, Ropper A, Zuniga G . Vasodepressor carotid sinus syncope associated with a neck mass. Neurology. 1992; 42(6):1194-7. DOI: 10.1212/wnl.42.6.1194. View

16.

Mairs A, Stewart T . Surgical treatment of glossopharyngeal neuralgia via the pharyngeal approach. J Laryngol Otol. 1990; 104(1):12-6. DOI: 10.1017/s0022215100111661. View

17.

Cicogna R, Bonomi F, Curnis A, Mascioli G, Bollati A, VISIOLI O . Parapharyngeal space lesions syncope-syndrome. A newly proposed reflexogenic cardiovascular syndrome. Eur Heart J. 1993; 14(11):1476-83. DOI: 10.1093/eurheartj/14.11.1476. View