Pediatric glossopharyngeal neuralgia with incidental trigeminal compression treated using microvascular decompression: illustrative case

Background: Glossopharyngeal neuralgia (GPN) is a rare condition typically manifesting as paroxysms of sharp, lancinating pain localized to the middle ear and auditory canal, base of the tongue, tonsillar fossa, and region just inferior to the angle of the mandible. Vascular compression is a common etiology, and microvascular decompression (MVD) has been established as a safe and efficacious treatment in adults. With the exception of one report of an adult patient undergoing the procedure for symptomatology that began in adolescence, there are no published cases of MVD for GPN in pediatric patients to the author's knowledge.

Observations: Here, the authors report a case of GPN in a 5-year-old boy with a 7-month history of medically refractory headaches and progressively worsening paroxysms of stabbing, "shock-like" pain in his right ear. Magnetic resonance imaging demonstrated neurovascular compression of the right glossopharyngeal nerve. Following MVD, the patient experienced a near-complete resolution of symptoms and a dramatic improvement in quality of life.

Lessons: GPN must be included in the differential diagnosis of all children presenting with head, neck, or pharyngeal pain and can be difficult to distinguish from Eagle's syndrome. MVD represents a safe and efficacious treatment for pediatric patients with GPN due to neurovascular compression. https://thejns.org/doi/10.3171/CASE24578.