Possible role of an endovascular provocative test in the diagnosis of glossopharyngeal neuralgia as a vascular compression syndrome

We utilized endovascular provocative techniques to identify the indications for microvascular decompression surgery in a serious case of glossopharyng eal neuralgia. This is the first reported case in which an endovascular pro vocative test was applied for diagnosis of glossopharyngeal neuralgia as a vascular compression syndrome. A 68-year-old woman presented with severe paroxysmal facial pain which coul d not be controlled by medical therapy. Partial effectiveness to carbamazep ine led us to wonder whether or not the selection of microvascular decompre ssion surgery would be appropriate. Pre-operative angiography was performed. During the examination a microcath eter was inserted into the right posterior inferior cerebellar artery (PICA ), and an attack of typical glossopharyngeal neuralgia occurred. The patien t thus underwent microvascular decompression surgery. The PICA was verified to compress the glossopharyngeal nerve and therefore was moved to induce d ecompression. The patient has since experienced no further pain for one yea r postoperatively. The diagnosis of glossopharyngeal neuralgia is sometimes complex and it is difficult to select the most appropriate surgical modality. In such cases t his endovascular provocative technique may thus be useful for making a defi nitive decision or microvascular decompression surgery.