In my experience, glossopharyngeal neuralgia, and more commonly vagoglossopharyngeal neuralgia, is a rare but exceptionally debilitating entity. Patients present in a similar fashion with paroxysmal pain in the deep throat, along with progressive hoarseness, which often radiates to the ear, and at times, may result in bradycardia, hypotension, and even syncope. A key point in the work-up is to avoid “stretching” the diagnosis. For example, the condition does not follow injury to the glossopharyngeal nerve, and microvascular decompression performed for such a patient is futile. Once a proper diagnosis has been made, heavily weighted T2 imaging directed at the first few millimeters only (ie, the centrally myelinated portion) of the glossopharyngeal nerve and the rostral rootlets of the vagus nerve should be utilized.¹ Parenthetically, the terms “root entry or exit zone” should be avoided as they are anatomically inexact, and we now have histopathological data nicely detailing the centrally myelinated portions of various cranial nerves.^2-4 When neurovascular compression is detected, the posterior inferior cerebellar artery is almost uniformly the culprit. I have not realized the need of utilizing open rhizolysis of the glossopharyngeal and vagus nerves, and vagoglossopharyngeal neuralgia (ie, of all the cranial neuralgias) recurs infrequently following microvascular decompression. This report⁵ does, however, provide some very nice data regarding expected outcomes in patients with sacrifice of the aforementioned nerves, which can be used to counsel patients undergoing procedures (e.g., resection of petroclival meningioma), which can result in injury to these nerves.

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评论：舌咽神经痛的神经外科选择：长期生活质量的益处-危害评估。

以我的经验，舌咽神经痛，更常见的是迷走舌咽神经痛，是一种罕见但异常衰弱的个体。患者以类似的方式出现在深喉处的阵发性疼痛，并伴随着逐渐发声的嘶哑，这种嘶哑通常辐射到耳朵，有时可能导致心动过缓，低血压甚至晕厥。进行检查的关键是避免“加重”诊断。例如，该状况不会随舌咽神经的损伤而发生，并且对该患者进行的微血管减压是徒劳的。一旦做出正确的诊断，仅针对前几毫米的重度T2成像 舌咽神经（迷走神经的中央髓鞘部分）和迷走神经的喙根应该被利用。¹顺便说一句，应避免使用“根部进入或离开区”，因为它们在解剖学上是不精确的，我们现在有组织病理学数据很好地详述了各种颅神经的中央髓鞘部分。^2-4当检测到神经血管受压时，小脑后下动脉几乎是罪魁祸首。我还没有意识到需要利用舌咽和迷走神经的开放性根治术，而微血管减压术后很少会出现迷走性舌咽神经痛（即所有颅神经痛）。本报告然而，图⁵确实提供了一些有关牺牲上述神经的患者的预期结果的很好的数据，这些数据可用于建议正在接受手术（例如切除岩斜脑膜瘤）的患者，这可能会导致这些神经的损伤。