The incidence of glossopharyngeal neuralgia is low, about 0.2C0.7/100,000/year, characterized by a brief but intense sharp pain, pins and needles sensation or burning sensation in one side of the pharynx, pharyngeal wall, tonsillar fossa, soft palate and posterior 1/3 of the tongue, radiating into the mouth or ear canal, similar in nature to trigeminal neuralgia. There is no significant difference in the incidence between men and women, and the disease mostly develops over 40 years of age. The pathogenesis of glossopharyngeal neuralgia is complex. In general, the pathogenesis of typical glossopharyngeal neuralgia is related to the compression of blood vessels in the brainstem area, and Jannetta proposed in 1977 that the compression of blood vessels in the brainstem area is the pathological basis of cranial neuropathy. We have achieved good results. Electron microscopy scans confirmed that long-term vascular compression and fluctuating impact on the nerve roots entering the medullary region can degenerate the nerve, causing demyelination and pseudosynaptic transmission, which leads to pain. The vessels responsible for lingual neuralgia are mostly the tortuous and sclerotic posterior inferior cerebellar artery trunk and basilar artery in the lateral pool of the cerebellar medulla and the variably thick vertebral artery, in addition to the anterior inferior cerebellar artery and adjacent thick veins. Secondary compression of the cranial nerves out of the brainstem area due to anatomical changes, as well as the arachnoid membrane with thickened adhesions that pull and compress the cranial nerves without obvious responsibility for vascular compression, can also produce neuralgia. In addition, the vagus nerve also plays a relevant role in the pathogenesis of glossopharyngeal neuralgia. In terms of nerve distribution, the glossopharyngeal nerve and the vagus nerve are closely related and overlap in the nucleus of the trigeminal spinal tract, and both are composed of nerve fibers emanating from the nucleus of the solitary tract. Therefore, some scholars believe that the pain in the deep external auditory canal and below the angle of the jaw originates from the Eustachian branch of the vagus nerve, so it is called “vagal glossopharyngeal neuralgia”. In addition, patients with glossopharyngeal neuralgia often have syncope due to the afferent nerve impulses reaching the nucleus of the solitary bundle of the midbrain and the dorsal motor nucleus of the vagus nerve through the reticular formation, resulting in reflex bradycardia or pause of the heartbeat and causing vagal syncope, which also confirms the involvement of the vagus nerve in the pathogenesis of glossopharyngeal neuralgia. Surgical procedures and techniques Surgical methods currently include manifest microvascular decompression and glossopharyngeal neurectomy, and there has been controversy over the years as to which of the two is the more reasonable procedure. Among them, the cure rate of MVD for glossopharyngeal neuralgia ranges from 76 to 90.3%, and the remission rate ranges from 9.7 to 16%. In microvascular decompression is taken by sharp separation method to thoroughly cut the arachnoid membrane around the posterior group of cranial nerve complex; probe the responsible vessels, do not miss the vessels located between the posterior group of cranial nerve roots and the medulla oblongata, move gently to reduce the number of strains on the linguopharyngeal and vagus nerves, and also to avoid the tearing of the penetrating branches; put cotton pads between the brainstem and the nerves, push the vessels away from the REZ area; the vessels are too thick or the vessels are too elastic, the When the vessel collaterals are long and the pressure points are too many to be pushed away from the REZ satisfactorily, the vessel can be removed by suspension method; if adequate decompression is not possible, nerve root dissection is performed. Due to the effects of pulling the nerve, separating the vessels, pad cotton compression, and nerve ischemia due to vasospasm, there are certain complications after MVD surgery. Hoarseness, choking on water, and discomfort in the throat occur. Although MVD surgery is definitely effective, with few and mild complications, and is adopted by most surgeons, due to the close arrangement of the linguopharyngeal nerve roots and vagus nerve roots, small interneural gaps, and adjacent to the funnel-shaped occipital foramen, the local operation space is small, and it is not easy to reveal the area out of the brainstem; the responsible vessels are mostly tortuous and sclerotic posterior inferior cerebellar artery trunk and/or vertebral artery, which are mostly hidden in the posterior lateral sulcus of the medulla oblongata, and there are more penetrating arteries, making the responsible The arteries responsible cannot be satisfactorily pushed, and the decompression of the vagus and glossopharyngeal nerves is not sufficient, and there is still a recurrence rate of 3.5~9.7%. The reason for postoperative recurrence is related to the presence of traffic between the vagus nerve and the linguopharyngeal nerve root, and it is recommended that linguopharyngeal nerve root + upper vagus nerve root filament dissection (rhizotomy, RT) should be the procedure of choice for the treatment of linguopharyngeal neuralgia, characterized by satisfactory efficacy and no recurrence. To compensate for the recurrence of pain in MVD surgery and the occurrence of neurological dysfunction after RT surgery, another new combined surgical procedure has been reported recently: microvascular decompression of the linguopharynx and vagus nerve + separate linguopharyngeal nerve dissection, all pain disappeared after surgery without recurrence, and since only the linguopharyngeal nerve was disconnected, the paralysis of the stem pharyngeal muscle may be compensated by the pharyngeal muscle group, so there is no postoperative hoarseness, water choking, sensory Therefore, there is no postoperative complication of neurological dysfunction such as hoarseness, choking and coughing, and sensory loss. In case of dissection, in order to reduce recurrence and serious complications after dissection, the linguopharyngeal nerve must be completely dissected to reduce adhesions at the severed end, and at the same time, at least one to two vagus nerve root filaments should be dissected, and when the vagus nerve root filaments are fewer and thicker, only the upper first root filament should be dissected or only partially dissected. In summary, after careful long-term evaluation of the respective advantages and disadvantages of MVD and RT, we recommend ① Adequate decompression of the axial aspect of the hyohypopharyngeal nerve and vagus nerve, as well as the exiting brainstem area, especially a sharp release of the thickened and adherent arachnoid membrane, and decompression of the hyohypopharyngeal and vagus nerves to the full extent of the intracranial process, on the basis of the ability to fully expose the responsible vessels and to completely free them and fully decompress them. If the responsible vessel is obscured by the nerve, or if the responsible vessel is too large and the local space is too narrow to fully free the vessel, or if the arachnoid inflammatory adhesions are too tight to be fully released and decompressed, then 1-2 filaments of the hyohypopharyngeal nerve root and the upper part of the vagus nerve root must be performed. The long-term results can only be achieved with good results.