title: Glossopharyngeal neuralgia treated with an endoscopic assisted midline suboccipital subtonsillar approach: technical note.
abstract: BACKGROUND
  Glossopharyngeal nerve neuralgia (GPN) is an exceptionally rare skull-based disorder. It is treated similar to other neurovascular conflicts. The approach, however, is debatable, as the caudal cranial nerves and especially the exit zones at the brainstem are barely visible via the retrosigmoid approach.
  
  
  METHODS
  We demonstrate a case of a typical GPN with microsurgical neurovascular decompression according to standard procedures. Continuous electrophysiological monitoring, including motor-evoked potentials of the glossopharyngeal nerve in addition to somatosensory evoked potential (SSEP) monitoring, was set up. In prone position a midline suboccipital osteoplastic craniotomy was performed. Intradurally, an endoscopic-assisted subtonsillar exposure of the lateral recess and the nerve root exit zone of the glossopharyngeal nerve has been chosen. A large compressing branch of the posterior inferior cerebellar artery (PICA) was identified as the cause of the neurovascular conflict and transposed.
  
  
  CONCLUSIONS
  A midline subtonsillar approach with endoscopic assistance to the lateral brainstem is a straightforward time- and morbidity-sparing procedure.
authors.affiliation: Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany. f.roser@gmx.de
authors.forename: Florian
authors.initials: F
authors.lastname: Roser
authors.forename: Florian Heinrich
authors.initials: FH
authors.lastname: Ebner
authors.forename: Martin U
authors.initials: MU
authors.lastname: Schuhmann
authors.forename: Marcos
authors.initials: M
authors.lastname: Tatagiba
mesh_terms: D000328:Adult; D000758:Anesthesia; D003399:Craniotomy; D004576:Electromyography; D004724:Endoscopy / Q000379:methods*; D019054:Evoked Potentials, Motor / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D020435:Glossopharyngeal Nerve Diseases / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures / Q000379:methods*; D009777:Occipital Bone / Q000601:surgery*; D016896:Treatment Outcome