Case Report: Glossopharyngeal neuralgia secondary to syncope: insights into microvascular decompression treatment

This article reports a case of a 56-year-old male patient with glossopharyngeal-vagal nerve syndrome. The main clinical manifestations were paroxysmal, sharp, knife-like pain in the right root of the tongue and pharynx, which occurred synchronously with syncope without any premonitory dizziness or nausea during pain episodes. Preoperative imaging suggested neurovascular compression, with the right posterior inferior cerebellar artery traversing and compressing the rootlets of both the glossopharyngeal nerve and proximal vagus nerve. The patient underwent a right retrosigmoid craniotomy for microvascular decompression targeting both nerves. Postoperatively, the patient's tongue root pain and pain-induced syncope resolved completely. The patient recovered well without serious complications. Notably, 24-h Holter monitoring captured real-time synchronous sinus bradycardia strictly matched with pain attacks, providing direct objective neurophysiological evidence for the pain-triggered cardioinhibitory reflex. A 6-month long-term follow-up further confirmed sustained resolution of all symptoms, without sensory deficits, recurrent neuralgia or syncope. This case confirms that microvascular decompression is a safe and effective treatment for glossopharyngeal-vagal nerve syndrome, addressing the root cause of both pain and syncope. It also highlights a easily misdiagnosed clinical phenotype and provides novel electrophysiological and surgical references for this rare cranial nerve disorder.