Abstract
Objectives Demonstrate the surgical treatment of geniculate neuralgia via microvascular decompression
and nervus intermedius sectioning.
Designs Single case-based operative video.
Setting Tertiary center with dedicated skull base team.
Participants The patient is a 62-year-old female with a history of deep right-sided otalgia consistent
with geniculate neuralgia. She failed appropriate medical treatment. Her magnetic
resonance imaging (MRI) showed an ectatic vertebrobasilar system as well as an anterior
inferior cerebellar artery (AICA) loop causing compression of the VII/VIII nerve complex
in the cerebellopontine angle.
Main Outcome Measures Resolution of right-sided otalgia.
Results The patient underwent retrosigmoid craniotomy with microvascular decompression of
the VII/VIII nerve complex and nervus intermedius sectioning. Intraoperatively, the
patient was noted to have an ectatic vertebral artery and AICA that were compressing
the root entry zone of the VII/VIII nerve complex. Microvascular decompression was
performed of both the vertebral artery and AICA with Teflon. The nervus intermedius
was sharply sectioned. The patient's postoperative course was uneventful with no complications.
She continues to have resolution of her right sided otalgia at 6 months postoperatively.
The link to the video can be found at: https://youtu.be/uRb_QfrINSk.
Keywords
geniculate neuralgia - microvascular decompression - nervus intermedius - retrosigmoid
craniotomy - ear pain - otalgia - nerve sectioning
