Geniculate Neuralgia: Long-term Results of Surgical Treatment

Abstract

A rare cause of otalgia is geniculate neuralgia. In its most typical f orm, it is charac terized by seve re paroxysmal neuralgic pain centered directly in the ear. The pain can be ofa gradual onset and ofa dull, persistent nature, but occasionally it is sharp and stabbing. When the pain becomes illtractabl e, all operation to surgically excise the nervus intermedius and geniculate ganglion via the middle cranial fossa approa ch is indicated. The pu rpose of this article is to review the long-term outcom es in 64 patients who were treated ill this manner. Findings indicate that excision of the nervus intermedius and geniculate ganglion call be routinely performed without causing fac ial paralysis and that it is an effective defi nitive treatmentfor intracta ble geniculate neuralgia.

Geniculate neuralgia: a systematic review

“…Therefore, 18 papers were included in the review. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] All reports directly related to geniculate neuralgia were classified as level 4 evidence, consisting of single case reports or small case series. There were two level 1 systematic reviews, which discussed the medical therapy of neuralgia.…”

“…However, all patients had permanent non-lacrimating ipsilateral eyes after the surgery. 3 Rupa et al 4 published a review of their experience in the surgical management of primary otalgia. They performed multiple nerve transections and microvascular decompression via a middle cranial fossa approach, a posterior cranial fossa approach or a combined approach in 18 patients.…”

Microvascular decompression may be an effective treatment for nervus intermedius neuralgia

“…[1][2][3] Nowadays, patients are treated medically, with varying degrees of success. Various treatments have been used for this latter condition, including section of the nervus intermedius, nervus petrosus major and/or geniculate ganglion.…”

Pain-free and pain-controlled survival after sectioning the nervus intermedius in nervus intermedius neuralgia: a single-institution review

“…14 After ruling out other nonneuralgic forms of otalgia, this complicated innervation can lead to diagnostic uncertainty surrounding the culprit nerve in primary otalgia. 7 Recent systematic reviews in otolaryngology and neurosurgery reveal a significant gap in the NIN literature, with fewer than 150 total cases published between 1932 and 2012. 13 Most of these are single case reports or case series.…”

“…5 For patients with known NVC, a microvascular decompression (MVD) is sometimes performed instead of, or as an adjunct to, sectioning the NI. 7 MVD is a procedure in which the culprit vessel is identified, and a piece of Teflon padding is placed between the vessel and the nerve. A variety of combinations of procedures has been reported in the literature, making comparisons of outcomes between studies difficult.…”