Glossopharyngeal neuralgia is an episodic and severe pain confined to the distribution of the glossopharyngeal nerve. The etiology and pathogenesis are not fully understood, but may be the result of a “short circuit” between the afferent impulses of the glossopharyngeal nerve and the vagus nerve caused by demyelination of the nerve. It can also be caused by tumors in the jugular foramen, skull base, nasopharynx, tonsils, etc., local arachnoiditis or aneurysm, which are called secondary linguopharyngeal neuralgia. In recent years, the development of microvascular surgery has revealed that in some patients, the linguopharyngeal nerve is caused by compression of the superior cerebellar artery, vertebral artery, or posterior inferior cerebellar artery. Patient ***, male, 42 years old, had a history of 5 years. The intraoperative photograph showed significant thickening and adhesion of the arachnoid membrane on the surface of the glossopharyngeal nerve and vagus nerve, as well as compression by abnormal arterial vessels. It is similar in nature to trigeminal neuralgia and can be triggered by swallowing, speaking, coughing, yawning, etc. It is mostly located in the tonsils, root of the tongue, pharynx, deep part of the ear canal, etc. It is intermittent and lasts from a few seconds to 1 to 2 minutes each time, with painful trigger points at the posterior pharyngeal wall, root of the tongue and tonsillar fossa. Some patients may have spasms of the pharyngeal muscles, cardiac arrhythmias, and hypotensive syncope. The symptoms manifested by glossopharyngeal neuralgia can be basically classified as follows: 1. Preferred age: 35-55 years old. 2. Site of onset: tonsillar region, pharynx, tongue root, neck, deep ear canal, and posterior mandibular region. 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. 5.The patient has foreign body sensation and obstruction: there is foreign body sensation and obstruction in the pharynx and larynx at the onset, and it leads to frequent coughing. 6. Palpation can cause pain, also called “trigger point”. It is commonly found in the tonsil area, external auditory canal, and tongue root. Pain can be triggered whenever swallowing, chewing, yawning, or coughing. There are clear intervals. Some patients become severely dehydrated and even wasted due to fear of pain and less food. 7. Severe patients may experience cardiac arrhythmia, cardiac arrest, fainting, convulsions, seizures, laryngeal muscle spasms, and excessive secretion of parotid glands. According to the different causes of the disease, the same can also be divided into primary and secondary glossopharyngeal neuralgia. The cause of primary glossopharyngeal neuralgia remains unclear and may be due to nerve desheathing. Secondary glossopharyngeal neuralgia can be caused by tumors of the cerebellopontine horn, spider retinitis, vascular disease, nasopharyngeal tumors, or hypertelorism. The main manifestations of secondary linguopharyngeal neuralgia are as follows: 1. Pain in the region of the linguopharyngeal nerve division. The pain attack lasts for a long time or is persistent, and the triggering factors and boarder points are not obvious, and are heavier at night. Symptoms of damage to the linguopharyngeal neuralgia. Paralysis of the jaw arch, decreased or absent sensation in the soft palate and pharynx, impaired taste and general sensation in the posterior third of the tongue, decreased or absent pharyngeal reflex, and abnormal secretion function of the parotid gland. 2. Adjacent cerebral neuralgia. Jugular foramen syndrome and Horner’s syndrome may appear; cerebellopontine angle syndrome may also appear. 3. If caused by nasopharyngeal cancer, a mass may be found in the nasopharynx and the lymph nodes in the neck may be enlarged. Diagnosis and differentiation: 1. Ask about the location and nature of the pain, whether it is related to diet, and whether the pain radiates to the ear in the medical history. 2. Ask the patient to eat and observe the trigger point for pain. Whether the trigger point is at the tonsillar trap, apply cocaine solution to the affected pharynx to find out whether the pain is relieved. 3.The nasopharynx and posterior group of cerebral nervous system were examined for any positive signs. 4.The main difference between the diagnosis and trigeminal neuralgia and tumor in the pontocerebellar horn should be identified. For clearly diagnosed linguopharyngeal neuralgia, surgery should be performed as early as possible, and the following surgical methods are available: 1.Linguopharyngeal nerve root decompression: under the operating microscope, the vertebral artery or posterior inferior cerebellar artery can be seen to cross and compress the linguopharynx and vagus nerve root filaments, and the blood vessels are separated, and the two are padded with cotton pads between the blood vessels and the nerve. The vessel is separated from the nerve and the two are spaced apart with a cotton pad. Intraoperative cardiovascular reactions are more frequent in this procedure than in dissection, and care should be taken during the surgical operation. It is important to pay attention to the patient’s sphygmomanometer respiratory rate and to work closely with the anesthesiologist. 2.Intracranial linguopharyngeal nerve root dissection: The linguopharyngeal nerve and vagus nerve root filaments are revealed from the posterior cranial fossa entrance, below the pontocerebellar angle, and 1~2 filaments of the upper part of the vagus nerve are further dissected while the linguopharyngeal nerve root filaments are dissected, which helps to improve the surgical result. According to statistics, 90% of the patients have immediate postoperative pain relief, and the recurrence rate after surgery is not high, and a second surgery is feasible for a very small number of recurrences after surgery. After linguopharyngeal nerve dissection, there is ipsilateral 1/3 loss of taste, numbness in the soft palate, tonsillar area and tongue root, mild soft palate prolapse and transient dysphagia, which causes little pain to the patient. 3. Percutaneous puncture of the linguopharyngeal nerve with radiofrequency thermocoagulation: the principle is to apply directional puncture and radiofrequency thermocoagulation to destroy the linguopharyngeal nerve and vagus nerve located at the jugular foramen. The needle is inserted at 2.5 cm outside the corner of the affected side of the mouth, and the needle is guided to enter the jugular foramen by taking lateral cranial and skull base films during the process of needle insertion, followed by 0.1~0.3V pulse current stimulation to precisely locate the nerve, and when the patient has pharyngeal pain, ear pain and cough after stimulation, it means that the nerve has been hit, and then the radiofrequency current is turned on to gradually increase the temperature and thermal coagulation to destroy the nerve. Therefore, this operation is not suitable for primary glossopharyngeal neuralgia, but only for secondary glossopharyngeal neuralgia caused by malignant tumors of the head and neck that have already caused vocal cord paralysis. In 2009, more than 200 cases of intracranial nerve microvascular decompression were completed, further clarifying that microvascular decompression is the safest and most effective surgical treatment method at present, and its cure rate can reach 99%. The surgical treatment is suitable for: (1) those who failed 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. Most patients’ pain can disappear after surgery, and 99% of patients can be cured. Microvascular decompression is the only method to treat the cause of glossopharyngeal neuralgia and can preserve the anatomical integrity of the glossopharyngeal nerve, and the normal nerve 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.