Glossopharyngeal neuralgia is a rare painful twitch with a ratio of approximately 1:70 to trigeminal neuralgia, which occurs in adults over 40 years of age without gender differences. As with trigeminal neuralgia, the exact cause of this disease is unknown. 25% of cases of glossopharyngeal neuralgia are associated with tumors of the pontocerebellar horn or nasopharynx, such as those originating from the carotid artery, pharynx, larynx, tonsils, and tongue. Other causes include vascular lesions such as carotid shrapnel injury, vertebral artery sclerosis, vertebral artery aneurysm, residual subungual artery, and arachnoiditis, stem overgrowth, and ossification of the ligament of the stem hyoid bone. Recently, Jannetta et al. found that the linguopharyngeal nerve roots and vagus nerve roots near the brainstem in a significant proportion of patients were compressed by abnormal vascular pathways, and most of the vessels causing compression were the posterior inferior cerebellar artery, vertebral artery and its branches, etc. The pathogenesis is similar to that of trigeminal neuralgia. The nature of pain is similar to that of trigeminal neuralgia, but the location of pain, triggering factors and accompanying symptoms are different. 1. The pain attack is limited to the division of the linguopharyngeal nerve and the ear and pharyngeal branches of the vagus nerve. The typical manifestation is paroxysmal severe pain at the back of the throat, tonsils and tongue root and deep part of the ear canal. The pain usually starts in the larynx, tonsillar fossa and the root of the tongue. Patients often have difficulty locating the pain because it is so severe. The pain may radiate to the ear canal, jaw and gums. The pain is confined to one side as its characteristic. 2. The nature of the pain is cut, pinprick, electrocution-like sudden attacks, intense and short-lived, from a few seconds to one minute. The episodes range from several to dozens of times a day. There are intervals of varying duration, during which the patient is normal. 3. Talking, eating, coughing, tongue extension, yawning, sneezing, and inhalation are often pain triggers. The attack may be accompanied by salivation and paroxysmal cough, laryngeal spasm, cardiac rhythm disturbance, and in a few patients, even bradycardia, arrest, syncope and convulsions, similar to Adam-Stoke syndrome. 4.The disease rarely has “boarder point”, if there is, it is mostly located in the tonsillar fossa, the root of the tongue or the pharynx. 5. Although the pain is severe during the attack, there is no positive finding in the neurological examination. II. Diagnosis The diagnosis is generally not difficult for those with typical symptoms. When the pain is limited to the zygomatic arch root and the ear, it is difficult to distinguish from trigeminal neuralgia. If the pain can be induced by stimulating the tonsillar fossa in the larynx, or if the pain can be relieved by spraying dicaine in the tonsillar fossa during the pain attack, then the pain is considered to be linguopharyngeal neuralgia. If the pain is persistent and there are signs of pontocerebellar horn lesion, it should be considered as secondary linguopharyngeal neuralgia, and further examination is needed to clarify the cause. Treatment The principles and methods of treatment are basically the same as those of trigeminal neuralgia. If it is caused by tumor, the tumor should be removed. For the first occurrence and milder attacks, it should be treated with drugs first, and the drug usage is the same as trigeminal neuralgia. For those who are ineffective in drug treatment or have frequent and severe attacks, the following surgical treatment can be used. 1.Glottopharyngeal neurectomy There are two kinds of accesses: extracranial and intracranial surgery. The former is simple, but the effect is not long-lasting, while the latter can achieve longer-lasting pain relief, but requires craniotomy: ①Extracranial surgical approach: Adsan advocates cutting the linguopharyngeal nerve that travels between the internal and external carotid arteries and in front of the hypoglossal nerve. ②Intracranial surgical approach: the same as trigeminal neuralgia. However, only the highest one or two branches of the glossopharyngeal nerve and vagus nerve near the jugular foramen are severed. When the linguopharyngeal nerve is severed, a few patients may have increased blood pressure, and when the vagus nerve branches are severed, extra-period cardiac contractions, decreased blood pressure, or even cardiac arrest may sometimes occur, so close monitoring should be performed during surgery. The sensory loss due to linguopharyngeal nerve dissection is usually very mild, but there may be ipsilateral loss of taste in the posterior 1/3 of the tongue, numbness in the soft palate, tonsillar area and tongue root, dryness and discomfort in the pharynx and transient dysphagia. 2.Microvascular decompression surgery The surgical approach is the same as intracranial dissection of the linguopharyngeal nerve. Pay attention to observe and find whether there is any abnormal vascular compression at the exit of the linguopharyngeal nerve from the brainstem. Similar to the trigeminal nerve root microvascular decompression method, the abnormal vessels are relocated, and the linguopharyngeal and vagus nerves are isolated and protected from the brainstem segment. (See trigeminal neuralgia for details). 3, radiofrequency electrocoagulation of the linguopharyngeal nerve Because this method inevitably affects the motor roots of the linguopharyngeal nerve, it limits its application and is only suitable for those with cancer at the base of the skull and whose vocal cord function on the diseased side has been lost. It is not applicable to primary glossopharyngeal neuralgia. The puncture method is similar to that of trigeminal nerve hemianopsia: 62.5 px outside the corner of the mouth is the puncture point, and a mark is made 75 px in front of the external auditory foramen, with the medial view aligned with the midpoint of the pupil and the lateral view aligned with the mark in front of the ear, which is the standard method for puncturing the jugular foramen. From the skull base, the jugular foramen and the foramen ovale are in a straight line. After penetrating to the skull base and taking the film routinely to confirm the position of the needle tip, the cerebrospinal fluid is extracted by piercing the jugular vein hole, and stimulated with 100-300mv pulse square wave current, wave width 1ms, 10-75Hz, if it can induce pain in the patient’s ear and larynx, and can cause coughing and sternocleidomastoid muscle contraction when increasing the current, it indicates the correct position of the needle tip, at this time, the temperature can be gradually increased until 70℃, and continued for 2 minutes and then gradually Cool down the temperature to achieve the effect of destroying the sensory root.