How I do it: microvascular decompression for vago-glossopharyngeal neuralgia

When a neurovascular conflict is demonstrated on high-resolution MRI in patients with drug-refractory Vago-Glossopharyngeal neuralgia microvascular decompression is regarded as the most effective therapeutic option. The aim of surgery is to relieve the conflict, most often produced by the posterior inferior cerebellar artery, not infrequently in association with a compressive megadolicho-vertebrobasilar artery. This can be safely achieved by exposure of the Vago-Glossopharyngeal nerve complex through a retromastoid-retrosigmoid infrafloccular approach through the cisterna magna, allowing exposure the lateral medulla and root entry zone of the lower cranial nerves. This report provides our step-by-step recommended technique for optimal efficacy and safety.