Vascular Decompression for Glossopharyngeal Neuralgia: Variation

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There are circumstances, although rare, where the pain syndromes can overlap, and more specifically glossopharyngeal neuralgia can overlap geniculate neuralgia. This is a patient of mine whose pain was primarily in her ear. And there was some component of pain around her throat. And she underwent left-sided retromastoid craniotomy, and I'm going to review the findings in this case. Her pain had a typical cutaneous triggers. In other words, where she took a shower and water went in her ear, it caused severe neuralgic pain. The pain was very much piercing, electrical, deep in her ear. On MRI examination, she had evidence of a vascular loop on the left side at the level of the lower cranial nerves. Due to her disabling pain, she underwent a left sided retromastoid craniotomy. You can see the exposure at the lower cranial nerves and the vascular loop present at the level of these nerves. The loop has been mobilized. Interestingly, there is no distinction between cranial nerve nine and ten. First the loop is decompressed and pieces of shredded Teflon are placed. And I will go ahead and find the distinction between the nine and ten cranial nerves closer to the juggler frame. And and this is the nuance to find a distinction closer to the place where they enter their foramina. Here, you can see the distinction is more clear. I did a transect, the ninth cranial nerve, and obviously completed the microvascular decompression of the tenth cranial nerves. And this patient did remarkably well, long-term, in terms of relief of her pain. Thank you.

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