Lovely T J, Jannetta P J
Department of Neurological Surgery, University of Pittsburgh, School of Medicine, Pennsylvania, USA.
Am J Otol. 1997 Jul;18(4):512-7.
Geniculate ganglion or nervus intermedius neuraigia is an unusual condition resulting in deep ear pain with or without signs of atypical trigeminal neuralgia, deep face, or throat pain. This article describes an experience with 14 patients who came to the neurosurgical service at the University of Pittsburgh Medical Center with a diagnosis of geniculate neuralgia.
After failing conservative treatment and after undergoing neurologic, otologic, and dental evaluations, these 14 patients underwent 20 intracranial procedures consisting of retromastoid craniectomies with microvascular decompression of cranial nerves V, IX, and X with section of the nervus intermedius in most cases.
At operation, vascular compression of the nerves and nervus intermedius was found, which implicated vascular compression as an etiology of this disorder. Initially, 10 of 14 patients had an excellent outcome (71.5%), 3 experienced partial relief (21.5%), and there was 1 failure (7%). Ten patients were available for long-term (> 12 months) follow-up. Of these 10, 3 retained the excellent result (30%), 6 experienced partial relief (60%), and there was 1 failure (10%). Complications included one transient facial paresis, one facial numbness, one paresis of cranial nerves IX and X, one chemical meningitis, two cerebrospinal fluid leaks, and one superficial wound infection. Of those that fell from the excellent to partial category, this usually involved a return of atypical facial pain, but otalgia remained resolved.
Overall, good results (with excellent or partial relief) were found long term for 90% of patients in this series. The authors recommend microvascular decompression of cranial nerves V, IX, and X with nervus intermedius section for the treatment of geniculate neuralgia.
膝状神经节或中间神经神经痛是一种罕见病症，可导致耳部深部疼痛，伴或不伴有非典型三叉神经痛、面部深部或咽喉部疼痛症状。本文介绍了匹兹堡大学医学中心神经外科收治的14例诊断为膝状神经痛患者的治疗经验。
在保守治疗失败且经过神经科、耳科和牙科评估后，这14例患者接受了20次颅内手术，包括乳突后颅骨切除术，术中对第V、IX和X颅神经进行微血管减压，多数情况下同时切断中间神经。
手术中发现神经和中间神经存在血管压迫，提示血管压迫是该疾病的病因。最初，14例患者中有10例预后良好（71.5%），3例部分缓解（21.5%），1例治疗失败（7%）。10例患者获得长期（>12个月）随访。在这10例患者中，3例仍保持良好效果（30%），6例部分缓解（60%），1例治疗失败（10%）。并发症包括1例短暂性面部轻瘫、1例面部麻木、1例第IX和X颅神经轻瘫、1例化学性脑膜炎、2例脑脊液漏和1例浅表伤口感染。从预后良好转变为部分缓解的患者，通常是出现了非典型面部疼痛复发，但耳痛仍得到缓解。
总体而言，该系列中90%的患者长期预后良好（预后良好或部分缓解）。作者推荐采用对第V、IX和X颅神经进行微血管减压并切断中间神经的方法来治疗膝状神经痛。
