Nervus Intermedius Neuralgia Treated with Microvascular Decompression: A Case Report and Review of the Literature

Abstract

Nervus intermedius neuralgia is one of the craniofacial neuralgias, which is extremely rare compared with trigeminal or glossopharyngeal neuralgia. Despite its unique symptom, the aetiology remains unclear. We present a case of a surgically treated 36-year-old woman who suffered from paroxysmal stabbing deep-ear pain for over 10 years. Preoperative magnetic resonance imaging demonstrated a vascular loop compressing the root entry zone of the vestibulocochlear nerve between the seventh and eighth cranial nerves, suggesting nervus intermedius neuralgia as a cause of her pain. Surgical exploration revealed that the nervus intermedius was displaced upward by the anterior inferior cerebellar artery. Transposition of the artery from the brainstem relieved the patient’s neurological symptom immediately after the surgery, supporting the hypothesis that nervus intermedius neuralgia could be caused by neurovascular compression.

Endoscopy during neurotomy of the nervus intermedius for nervus intermedius neuralgia: a case report

“…The sensation of taste in two-thirds of the anterior tongue, and the general sensation in the area around the concha of the external ear and the external auditory canal are also controlled by the nervus intermedius (3). NIN is characterized by pain paroxysms felt in the depth of the ear, lasting for several seconds or minutes, and exhibiting intermittent occurrence; the pain is often accompanied by ipsilateral nasal mucosal congestion and tears; changes in taste and hearing may also be present (4). In our case, the paroxysmal pain was located in the deep left ear and spread to the auricle.…”

A pain in the ear: Two case reports of nervus intermedius neuralgia and narrative review

“…Note that the included cases are diagnosed as NIN, but this diagnosis may not have been confirmed and may not have even formally met ICHD‐3 criteria. As a result of this review, 61 papers were reviewed in full for inclusion, from which data on 127 cases were compiled from 33 publications, 2,6,8–38 with 30 of these publications discussing treatments 6,8–13,15–37,39 …”

“…The most common effective treatments reported in the literature were surgical procedures, 6,[8][9][10][11][12][13]15,16,18,[20][21][22]24,27,28,[30][31][32][33][34][35][36] including microvascular decompression, nerve sectioning, rhizotomy, and tractotomy. None of the surgical cases reported a poor response, although some did report requiring two to three procedures for a good response.…”

“…Given the preponderance of surgical reports, focused information on medical treatment was vague and often limited. [8][9][10]13,[15][16][17][19][20][21][22][23][24][25][26][27]29,30,32,33,[35][36][37]…”

“…A summary of the patient and clinical characteristics of the 127 NIN cases reviewed is shown in Table 1 2,6,8–38 . Cases were reported in all age groups (range 1–89 years, n = 102), with the mean age of occurrence being 45 years.…”