[Microvascular decompression for glossopharyngeal neuralgia: case report].

We report the case of a glossopharyngeal neuralgia that was successfully treated using microvascular decompression (MVD). A 61-year-old female reported intermittent piercing pain from tongue to pinna on the left side. Although she had been prescribed carbamazepine and has undergone attempted nerve block on several occasions, no pain relief has been achieved. MVD was thus attempted using a lateral suboccipital approach. The offending vessel, which was PICA, had adhered to the glossopharyngeal nerve and was repositioned laterally away from the nerve by interposition of a felt cushion. Pain disappeared immediately after surgery and has not recurred. In the literature, MVD for glossopharyngeal neuralgia has been performed using a transcondylar approach to achieve minimally invasive surgery. However, the sensory distributions for the floor of the oral cavity and tongue involve 4 overlapping nerves: the trigeminal nerve, sensory components of the facial and vagal nerves, and the glossopharyngeal nerve. In typical cases, it seems that the transcondylar fossa approach is appropriate for glossopharyngeal neuralgia. If the pain occurs in the place involving an overlapping nerve, the lateral suboccipital approach might be necessary.