Cranial Nerve IX and X Neurectomy for Glossopharyngeal Neuralgia: Case Report and Operative Video

BACKGROUND AND IMPORTANCE:Glossopharyngeal neuralgia (GPN) is a rare condition that is often misdiagnosed as trigeminal neuralgia. The condition is characterized by intermittent, severe pain in the distribution of the glossopharyngeal nerve. We present an illustrative case of GPN with an operative video detailing neurectomy of the glossopharyngeal nerve and the upper rootlets of the vagus nerve for treatment of idiopathic GPN in a patient with a history of squamous cell carcinoma.CLINICAL PRESENTATION:A 62-year-old man with a history of left mandibular alveolar squamous cell carcinoma status postresection presented with left-sided severe, paroxysmal pain in the posterior one-third of his tongue refractory to medical treatment and without evidence of recurrent malignancy or vascular compression on imaging studies. After he failed medical management, glossopharyngeal neurectomy was performed through a left suboccipital craniotomy during which cranial nerves IV, V, VI, VII/VII, IX, X, and XI were visually inspected for malignant recurrence, and the glossopharyngeal nerve and the upper 2 to 3 nerve rootlets of the vagus nerve were severed. The patient had immediate, complete, and durable resolution of his symptoms without any new neurological deficits.CONCLUSION:Glossopharyngeal neurectomy has been shown to be an efficacious surgical treatment for GPN, as first described by Walter Dandy in 1920. In this report, we describe the workup and treatment of GPN with important diagnostic considerations and present a detailed video demonstrating technical and anatomic considerations when performing glossopharyngeal neurectomy.