Vascular Decompression for Glossopharyngeal Neuralgia
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Let's review another video regarding microsurgical management of glossopharyngeal neuralgia. This is a young patient of mine who presented with left-sided glossopharyngeal neuralgia. And on MRI, was found to have a vascular loop in the area of the left lower cranial nerve corresponding to his left-sided pain. He subsequently went to left side retromastoid craniotomy. As you can see here, the edges of the dura are tacked up the curve of the dura of the petrous bone toward the posterior fossa is recognized. And the section over the lower cranial nerves, although exposure of the 9th and 10th cranial nerves. You can see the arachnoid over the 7th and 8th cranial nerves are left relatively intact and retraction parallel to them is avoided. A large vascular loop is found in this case, just at the level of the 9th cranial nerve. But again, most often the loop also compresses the root exit zone of the 10th cranial nerve. We went ahead and coagulated and cut the 9th nerve. As we discussed previously, it's more ideal to cut the nerve closer to the brain stem to avoid its stump interfering with our microsurgical work during decompression of the 10th cranial nerve. Here is a piece of shredded Teflon placed between the artery and the brain stem. These smaller pieces of shredded Teflon, are the model link of the region to assure that the nerve and the brainstem are adequately decompressed. Here is further pieces of Teflon placed between the artery and the brainstem.
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