Preoperative Assessment of Microvascular Compression of Cranial Nerve IX and X Using 3D Fast Imaging Employing Steady-state Acquisition Magnetic Resonance Imaging in Glossopharyngeal Neuralgia

摘要

We report a case of glossopharyngeal neuralgia associated with a vascular loop of the postero-inferior cerebellar artery, precisely diagnosed by preoperative magnetic resonance imaging (MRI) with a sequence of 3-dimensional fast imaging employing steady-state acquisition (3D-FIESTA). A 44-year old man experienced paroxysmal and excruciating pain, starting in the left tongue and descending to mandibular angle. Preoperative 3D-FIESTA-MRI delineated a small vascular loop compressing the vago-glossopharyngeal nerve at its cisternal portion. The patient underwent a microvascular decompression surgery. Intraoperative inspection revealed that the glossopharyngeal nerve root was in contact with a small arterial loop at its cisternal portion and was deformed as demonstrated by preoperative 3D-FIESTA-MRI. At the operation, we adopted the method of repositioning the offending loop of the postero-inferior cerebellar artery by lifting and attaching it to the nearby dura of the petrous bone with glue. The patient's neuralgia resolved immediately after the operation. 3D-FIESTA may be a useful method for visualization of microvascuiar compression of glossopharyngeal nerve in this relatively rare condition.