Geniculate neuralgia: Clinical, radiologic, and intraoperative correlates

Research output: Contribution to journalReview article

9 Scopus citations

Abstract

Objective: Geniculate neuralgia is an uncommon pain syndrome that can be severe and disabling and is difficult to diagnose. Methods: The literature was reviewed for geniculate neuralgia, including anatomy, presentation, and treatment. A case illustration was presented that demonstrates the novel brainstem functional imaging findings for geniculate neuralgia. A 39-year-old man presented with a history of left "deep" ear pain within his ear canal. He noted occasional pain on the left side of his face around the ear. He had been treated with neuropathic pain medications without relief. His wife described suicidal ideations discussed by her husband because of the intense pain. Results: The patient's neurologic examination was normal, and otolaryngologic consultation revealed no underlying structural disorder. Anatomic imaging revealed a tortuous vertebral artery-posterior inferior cerebellar artery complex with the posterior inferior cerebellar artery loop impinging on the root entry zone of the nervus intermedius-vestibulocochlear nerve complex and just inferior to the root entry zone of the facial nerve and a small anterior inferior cerebellar artery loop interposed between the cranial nerve VII-VIII complex and the hypoglossal and glossopharyngeal nerves. A left-sided retromastoid craniotomy was performed, and the nervus intermedius was transected. An arterial loop in contact with the lower cranial nerves at the level of the brainstem was mobilized with a polytetrafluoroethylene implant. Conclusions: The patient indicated complete relief of his preoperative pain after surgery. He has remained pain-free with intact hearing and balance.

Original languageEnglish (US)
Pages (from-to)e353-e357
JournalWorld Neurosurgery
Volume80
Issue number6
DOIs
StatePublished - Dec 1 2013

Keywords

  • Geniculate neuralgia
  • Magnetic resonance imaging
  • Nervus intermedius
  • Posterior fossa surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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