title: Microvascular decompression for glossopharyngeal neuralgia through the transcondylar fossa (supracondylar transjugular tubercle) approach.
abstract: OBJECTIVE
  Our surgical results were reviewed to clarify the cause of glossopharyngeal neuralgia (GPN) and the effects of the microvascular decompression (MVD) procedure.
  
  
  METHODS
  Fourteen cases of idiopathic GPN were operated on through the transcondylar fossa (supracondylar transjugular tubercle) approach. Their clinical data and operative records were retrospectively reviewed.
  
  
  RESULTS
  In every case, vascular compression on the glossopharyngeal nerve was found and MVD was performed without any major complications. In 13 of the 14 cases the neuralgia completely disappeared postoperatively. Recurrence of pain was found in 1 case. Offending vessels were the posterior inferior cerebellar artery (PICA) in 10 cases, the anterior inferior cerebellar artery (AICA) in 2 cases, and both arteries in 2 cases. In 10 of the 14 cases, the high-origin PICA formed an upward loop between the glossopharyngeal and vagus nerves, compressing the glossopharyngeal nerve upward. In those cases, the PICA was transposed and fixed to the dura mater by the stitched sling retraction technique, and MVD was very effective.
  
  
  CONCLUSIONS
  The offending artery was the PICA in most cases. MVD is expected to be very effective, especially when the radiological images show the following 3 findings: 1) high-origin PICA, 2) the PICA making an upward loop, and 3) the PICA coursing the supraolivary fossette. The transcondylar fossa approach is suitable for transposing the PICA by the stitched sling retraction technique, and provides sufficient surgical results.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan. MasatouAzu@aol.com
authors.forename: Masatou
authors.initials: M
authors.lastname: Kawashima
authors.forename: Toshio
authors.initials: T
authors.lastname: Matsushima
authors.forename: Tooru
authors.initials: T
authors.lastname: Inoue
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Mineta
authors.forename: Jun
authors.initials: J
authors.lastname: Masuoka
authors.forename: Naomi
authors.initials: N
authors.lastname: Hirakawa
mesh_terms: D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000098:blood supply / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005930:Glossopharyngeal Nerve / Q000473:pathology / Q000601:surgery; D020435:Glossopharyngeal Nerve Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008526:Medulla Oblongata / Q000098:blood supply / Q000601:surgery; D008833:Microcirculation / Q000502:physiology; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009777:Occipital Bone / Q000033:anatomy & histology / Q000098:blood supply / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods