title: Endovascular microcatheter provocation test for the diagnosis of glossopharyngeal neuralgia.
abstract: OBJECTIVE
  Glossopharyngeal neuralgia (GN) is a rare disease often clinically misdiagnosed as trigeminal neuralgia. An endovascular provocative test has been applied to assist in making the diagnosis of GN caused by vascular compression. We similarly used endovascular provocative techniques to identify the causative vessel and to evaluate the indication for microvascular decompression (MVD) in two patients.
  
  
  METHODS
  Two patients had severe retroauricular and pharyngeal pain that could not be controlled by medical therapy. Magnetic resonance imaging and magnetic resonance angiography showed a high-riding right posterior inferior cerebellar artery (PICA). We decided to apply the endovascular provocation test to prove the assumed GN and identify potential indications for MVD.
  
  
  RESULTS
  A loop of the PICA appeared to compress the glossopharyngeal nerve in the first patient. In this patient, a microcatheter was inserted into the right PICA, decreasing the GN. The patient underwent MVD, resulting in complete pain relief. In the second patient, a microcatheter was inserted into the right PICA, and an attack of typical GN occurred, with pain in the posterior region of the tongue, tonsils, oropharynx, and larynx. The patient's severe pain was clearly different from this typical GN caused by the microcatheter provocation test, and MVD was not performed.
  
  
  CONCLUSIONS
  The diagnosis of GN is sometimes complex. The endovascular provocative technique may allow identification of GN caused by vascular compression.
authors.affiliation: Department of Neurosurgery, Kinki University, Osaka-sayama, Osaka, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakano
authors.affiliation: Department of Neurosurgery, Kinki University, Osaka-sayama, Osaka, Japan.
authors.forename: Norihito
authors.initials: N
authors.lastname: Fukawa
authors.affiliation: Department of Neurosurgery, Kinki University, Osaka-sayama, Osaka, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Nakagawa
authors.affiliation: Department of Neurosurgery, Kinki University, Osaka-sayama, Osaka, Japan.
authors.forename: Kinya
authors.initials: K
authors.lastname: Nakanishi
authors.affiliation: Department of Neurosurgery, Kinki University, Osaka-sayama, Osaka, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Tsuji
authors.affiliation: Department of Neurosurgery, Kinki University, Osaka-sayama, Osaka, Japan.
authors.forename: Tomonari
authors.initials: T
authors.lastname: Yabuuchi
authors.affiliation: Department of Neurosurgery, Kinki University, Osaka-sayama, Osaka, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Iwakura
authors.affiliation: Department of Neurosurgery, Kinki University, Osaka-sayama, Osaka, Japan.
authors.forename: Amami
authors.initials: A
authors.lastname: Kato
mesh_terms: D003937:Diagnosis, Differential; D057510:Endovascular Procedures; D005260:Female; D020435:Glossopharyngeal Nerve Diseases / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D014277:Trigeminal Neuralgia / Q000175:diagnosis*