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

## TL;DR

This paper describes a surgical technique for treating a type of nerve pain using microvascular decompression based on MRI findings.

## Contribution

The paper introduces a step-by-step surgical technique for microvascular decompression in vago-glossopharyngeal neuralgia.

## Key findings

- Microvascular decompression is effective for drug-refractory vago-glossopharyngeal neuralgia when MRI shows neurovascular conflict.
- The posterior inferior cerebellar artery is the most common cause of nerve compression.
- A retromastoid-retrosigmoid infrafloccular approach provides safe and effective surgical access.

## Abstract

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.

The online version contains supplementary material available at 10.1007/s00701-026-06824-4.