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Updated: Jul 17, 2026
Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Preoperative visualization of microvascular compression of cranial nerve IX using constructive interference in steady
Hiroshi Karibe1, Reizo Shirane, Takashi Yoshimoto
1Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan. karibe@nsg.med.tohoku.ac.jp
Abstract:
We report a case of successfully treated glossopharyngeal neuralgia, in whom preoperative magnetic resonance imaging (MRI) with a sequence of constructive interference in steady-state (CISS) precisely delineated microvascular compression to the glossopharyngeal nerve at its cisternal portion. A 70-year old female experienced paroxysmal and excruciating pain, starting in the right ear and descending to the tongue and throat. The pain was brief, burning and triggered by swallowing food and drinks. Preoperative CISS-MRI delineated a small vascular loop compressing the glossopharyngeal nerve at its cisternal portion. The patient was diagnosed with glossopharyngeal neuralgia, and then, microvascular decompression surgery was performed. Intraoperative inspection revealed that the glossopharyngeal nerve root was in contact with a small arterial loop at its cisternal portion and was deformed as demonstrated by preoperative CISS-MRI. The glossopharyngeal nerve was displaced using a piece of Teflon felt, freeing it from the arterial loop compression. The patient's neuralgia resolved immediately after surgery. During a period of 2-years follow up, no recurrence of the neuralgia has occurred. The usefulness of CISS-MRI for the diagnosis of glossopharyngeal neuralgia is discussed.
Insights
Successfully treated glossopharyngeal neuralgia using constructive interference in steady-state magnetic resonance imaging (CISS-MRI) to identify vascular compression. This diagnostic approach enabled precise surgical intervention and long-term pain relief.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Glossopharyngeal neuralgia is characterized by severe, episodic throat pain.
- Microvascular compression of the glossopharyngeal nerve is a common etiology.
- Accurate preoperative imaging is crucial for surgical planning.
Observation:
- A 70-year-old female presented with characteristic glossopharyngeal neuralgia triggered by swallowing.
- Preoperative CISS-MRI precisely identified a vascular loop compressing the glossopharyngeal nerve.
- Intraoperative findings confirmed the CISS-MRI results, revealing nerve deformation.
Findings:
- Microvascular decompression surgery, guided by CISS-MRI, successfully resolved the patient's neuralgia.
- The patient remained pain-free during a 2-year follow-up period.
- CISS-MRI demonstrated high diagnostic accuracy for identifying the causative vascular compression.
Implications:
- CISS-MRI is a valuable tool for diagnosing glossopharyngeal neuralgia.
- Early and accurate diagnosis facilitates effective surgical treatment.
- This case highlights the importance of advanced imaging in managing cranial nerve disorders.
