What is glossopharyngeal neuralgia? Glossopharyngeal neuralgia is a sharp, paroxysmal pain that occurs in the region of the glossopharyngeal nerve division. The pain occurs at the base of one side of the tongue, throat, tonsils, root of the ear and the back of the lower jaw, sometimes with pain at the root of the ear as the main manifestation. It is divided into two categories: primary and secondary. Liang Jiantao, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University The etiology and pathogenesis of the disease have not been completely clarified. It may be the result of a “short circuit” between the afferent impulses of the linguopharyngeal nerve and the vagus nerve caused by the demyelination of the nerve due to the compression of the linguopharyngeal nerve by blood vessels. These tumors can also be seen in the distribution area of the linguopharyngeal nerve and are called secondary linguopharyngeal neuralgia. Clinical features: 1. Age of predilection: middle-aged and elderly people over 40 years old. 2. 2. Site of onset: one side of the tonsil area, pharynx, tongue root, neck, deep ear canal, and posterior mandibular area. 3. Nature of pain: paroxysmal severe pain, such as knife-like, stabbing-like, painful convulsions. 4. Time of pain: frequent in the morning and morning, and there may be episodes during sleep, which can be distinguished from trigeminal neuralgia. 5. Foreign body and obstruction sensation: there is a foreign body and obstruction sensation in the pharynx and larynx at the onset, which leads to frequent coughing. 6. Pain-triggering factors: Pain can be triggered by palpation, also known as “trigger point”. It is commonly found in the tonsil area, external auditory canal, and tongue root. Pain can be triggered by swallowing, chewing, yawning, and coughing. 7. There are intermittent periods. 8. The patient has dehydration and wasting. It is caused by the fear of pain and less food intake. Microvascular decompression surgery Microvascular decompression surgery is the safest and most effective surgical treatment at present, and its cure rate can reach 90%. Most patients’ pain disappears after surgery, and more than 90% of patients can be cured. Microvascular decompression was first introduced by Professor Jannatta in 1967. Microvascular decompression is performed by lying the patient on his side, making a transverse or longitudinal incision of about 4 cm behind the ear, using a posterior sigmoid sinus approach with a bone window of about 1.5 cm × 1.5 cm and a “⊥” shaped incision of the dura mater to release part of the cerebrospinal fluid to make the cerebellum sink and then enter the pontocerebellar horn. The arachnoid was cut and the cerebral nerves VII, VIII, IX and X were explored. The arachnoid around the linguopharyngeal nerve and vagus nerve roots were fully released, the responsible vessels inside the linguopharyngeal nerve and vagus nerve roots were explored, the linguopharyngeal and vagus nerves were separated from the surrounding vessels, and the nerves and vessels were permanently isolated with non-absorbable Tefflon cotton sheets. Microvascular decompression is the only treatment that addresses the etiology of glossopharyngeal neuralgia and preserves the anatomical integrity of the glossopharyngeal nerve, so that normal neurological function of the glossopharyngeal nerve can be preserved. In some patients, it can also eliminate the hypertensive state caused by vascular compression of the brainstem and achieve a radical cure for hypertension. Because microvascular decompression has the advantages of obvious pain relief, non-destructive, few side injuries, and very low recurrence rate, it is currently the safest and most effective method internationally recognized for the treatment of glossopharyngeal neuralgia.