Geniculate neuralgia: clinical, radiologic, and intraoperative correlates.

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.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Tubbs RS,Mosier KM,Cohen-Gadol AA

doi

10.1016/j.wneu.2012.11.053

subject

Has Abstract

pub_date

2013-12-01 00:00:00

pages

e353-7

issue

6

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(12)01352-6

journal_volume

80

pub_type

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