Title: Surgical Management of Geniculate Neuralgia: The Necessity of Nervus Intermedius Sectioning and Multi-Cranial Nerve Assessment

AIM: Geniculate neuralgia (GN) is a rare craniofacial pain syndrome characterized by severe lancinating pain in the ear.1 Its diagnosis is complex due to the sensory overlap of cranial nerves (CN) V, VII, IX, and X. We present two cases of GN treated via a retrosigmoid approach to discuss diagnostic criteria and the surgical necessity of Nervus Intermedius (NI) sectioning versus microvascular decompression (MVD) alone.
MATERIAL and METHODS: Two patients with long-term follow-up (4 and 8 years) were reviewed. Case 1 was a 34-year-old female with lightning-like otalgia. Intraoperatively, no vascular compression was found; NI sectioning was performed. Case 2 was a 51-year-old male with otalgia and dysequilibrium who underwent MVD of CN VII and vein coagulation.
RESULTS: In Case 1, the patient reported immediate and complete pain relief and remains medication-free at the 4-year follow-up. In Case 2, postoperative relief was incomplete initially. At the 8-year follow-up, although the patient is stable, he requires low-dose carbamazepine maintenance.
CONCLUSION: Precise diagnosis of GN requires strictly defined pain characteristics (duration <2 minutes, localized to the ear). Given the complex sensory innervation, surgical exploration must assess CN V and IX. However, for definitive GN, NI sectioning provides superior and immediate curative results compared to MVD alone

Geniculate neuralgia Nervus intermedius Sectioning Otalgia