A Case Report of Pediatric Geniculate Neuralgia Successfully Treated with Sectioning of the Nervus Intermedius and Microvascular Decompression of the Cranial Nerves IX and X

Background: Classic geniculate neuralgia is a rare condition characterized by intermittent lancinating pain centered in the ear, sparing the throat, and that is likely the result of a vascular compression syndrome. To the best of our knowledge, no case of pediatric geniculate neuralgia has been reported in the English literature.

Case Presentation: We present the first case of successfully treated pediatric geniculate neuralgia. The patient was a 9 year-old boy who presented with one year history of intermittent lancinating right ear pain, often precipitated by chewing and swallowing. Extensive evaluation by multiple specialties (ENT, dentist, neurology, allergy and immunology etc.) did not reveal a cause for his pain. The pain improved marginally with neuroleptics, which did however produce significant side effects. Imaging disclosed a tortuous loop of the right posterior inferior cerebellar artery abutting cranial nerves IX and X but no other abnormalities. Given the protracted and debilitating symptoms surgery was offered. The patient underwent an endoscopic microvascular decompression of cranial nerves IX and X, and sectioning of the nervus intermedius through a right retromastoid craniotomy. There were no complications from the surgery. Post-operatively, the patient reported complete resolution of his symptoms that persisted at 3 months of follow-up.

Conclusion: Geniculate Neuralgia can rarely affect the pediatric population. In carefully selected patients with consistent clinical and radiographic presentation, sectioning of the nervus intermedius, and microvascular decompression of the lower cranial nerves may provide long lasting resolution of symptoms.