Glossopharyngeal neuralgia is an episodic and severe pain confined to the posterior tongue and throat of the Eustachian branch of the glossopharyngeal nerve or vagus nerve that radiates to the external ear. It is much less common than trigeminal neuralgia, with a ratio of 2:100, and is most common in middle-aged and elderly people. The cause of the disease is still unknown, but microvascular compression of the glossopharyngeal nerve may be the main cause. The pain is caused by the compression of the linguopharyngeal and vagus nerves by blood vessels such as the posterior inferior cerebellar artery, which causes demyelination of the linguopharyngeal and vagus nerves, resulting in a “short circuit” between the afferent impulses of the linguopharyngeal nerve and the vagus nerve. Wang Hao, Department of Neurosurgery, Hangzhou First People’s Hospital, said that clinical symptoms are more common in men than in women, and the onset of the disease is mostly after the age of 35. The pain is confined to the area innervated by the linguopharyngeal nerve and the auricular and pharyngeal branches of the vagus nerve, namely the posterior pharyngeal wall, tonsillar fossa, tongue root and deep external auditory canal, etc. It may radiate to the external ear, jaw and gums. The pain is usually unilateral, and only 2% of cases are bilateral. The pain is like a cut, a pinprick, or an electric shock, with sudden onset and intensity, lasting from a few seconds to a minute, and ranging from several to dozens of attacks per day. In most cases, there are distinct periods of flare-ups and periods of quiescence, sometimes lasting for more than a year, but they do not resolve spontaneously. The pain is usually triggered by movements such as eating, swallowing, or speaking. About 10% of glossopharyngeal neuralgia is combined with trigeminal neuralgia. If the pain disappears by spraying the posterior pharyngeal wall or tonsillar area with 4% cocaine or 1% pontocaine, it can be distinguished from trigeminal mandibular branch pain. The diagnosis of glossopharyngeal neuralgia is mainly based on clinical manifestations and does not rely on imaging examinations. However, imaging tests, such as CT, MRI, DSA, etc., can help to distinguish primary and secondary glossopharyngeal neuralgia. Primary glossopharyngeal neuralgia is a case in which the root of the glossopharyngeal and vagus nerves is compressed by abnormal alignment vessels that cause pain. Sometimes the pain can be relieved by pulling on the earlobe on the painful side. The treatment principle of primary glossopharyngeal neuralgia: drug treatment should be preferred after clear diagnosis, and non-drug treatment should be used when drug treatment is ineffective or obvious drug adverse reactions occur. Any drug used to treat primary trigeminal neuralgia can also be applied to this disease. Commonly used drugs include carbamazepine, phenytoinamide, heptaerythrone, baclofen, etc. Nerve block treatment: the method is percutaneous puncture jugular vein hole radiofrequency treatment. It is suitable for: (i) those who are ineffective in drug treatment or cannot tolerate the adverse effects of drugs (ii) those who are elderly or in poor general condition and cannot tolerate craniotomy (iii) cases with combined multiple sclerosis. The main problems of this treatment are high recurrence rate of pain (23%-54%) and dysphagia, choking and hoarseness due to nerve damage. Microvascular decompression is the safest and most effective surgical treatment for primary glossopharyngeal neuralgia, while other surgical methods are less commonly used due to poor treatment results and surgical complications. The surgical treatment is suitable for: (1) those who fail in drug or percutaneous puncture treatment; (2) those who have good general condition, no serious organic lesions and can tolerate surgery; (3) those who exclude lesions such as multiple sclerosis or pontocerebellar horn tumor, etc. Most patients’ pain can disappear after surgery, and 92% of patients can be cured. Microvascular decompression surgery is performed by pushing away the blood vessels that are located in the root of the linguopharynx and vagus nerve and cause compression of the linguopharynx and vagus nerve under the operating microscope, and fixing them so that they do not touch the linguopharynx and vagus nerve, thus relieving the compression of the linguopharynx and vagus nerve, restoring the normal function of the linguopharynx and vagus nerve, and relieving the pain symptoms. It is not necessary to sever the linguopharyngeal nerve and part of the vagus nerve root filament. With the improvement of this surgical technique, especially its minimally invasive, high safety, remarkable effect and low recurrence rate and complications, especially the ability to completely preserve the function of blood vessels and nerves, it is the most effective treatment method for linguopharyngeal neuralgia at present. The procedure is performed under general anesthesia and is painless for the patient. The incision is made in the hairline behind the affected ear, about 6 cm long, and a small hole of 2.5 cm in diameter is drilled in the skull. Our hospital carries out research and clinical treatment of glossopharyngeal neuralgia, and has treated nearly dozens of patients so far, achieving satisfactory treatment results, with a cure rate of 92% after years of long-term follow-up.