title: Microvascular decompression of the posterior inferior cerebellar artery for intermediate nerve neuralgia.
abstract: BACKGROUND
  Intermediate nerve neuralgia (INN) is an extremely rare craniofacial pain disorder mainly caused by neurovascular compression.
  
  
  METHODS
  We present the case of a 48-year-old female with a 20-month history of intractable paroxysmal INN on the right side. The patient described feeling paroxysmal pain in her auditory canal, pinna, deep in the jaw, and adjacent retromastoid area on the right side. She described the pain as being like a burning sensation. Magnetic resonance imaging showed the right posterior cerebellar artery crossing the cerebellopontine cistern in close contact with the right VII and VIII nerves. Surgical exploration via retromastoid craniotomy revealed vascular compression of the intermediate nerve by the posterior cerebellar artery. We therefore performed microvascular nerve decompression to relieve pain, and the patient remained pain-free at the 6-month follow-up visit.
  
  
  CONCLUSIONS
  INN should be considered as a differential diagnosis in cases with atypical facial neuralgia, and microvascular decompression is an effective treatment option that can provide optimal pain relief.
authors.affiliation: Division of Functional Neurosurgery, Department of Neurology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Humberto Kluge
authors.initials: HK
authors.lastname: Schroeder
authors.affiliation: Division of Functional Neurosurgery, Department of Neurology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Iuri Santana
authors.initials: IS
authors.lastname: Neville
authors.affiliation: Division of Functional Neurosurgery, Department of Neurology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Daniel Ciampi
authors.initials: DC
authors.lastname: de Andrade
authors.affiliation: Division of Functional Neurosurgery, Department of Neurology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Guilherme Alves
authors.initials: GA
authors.lastname: Lepski
authors.affiliation: Division of Functional Neurosurgery, Department of Neurology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.affiliation: Division of Functional Neurosurgery, Department of Neurology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Kleber Paiva
authors.initials: KP
authors.lastname: Duarte
keywords: Cranial neuralgia; intermediate nerve neuralgia; microvascular decompression surgery; neuralgia; neuropathic pain; paroxysmal nerve pain; posterior inferior cerebellar artery