Microvascular decompression of the glossopharyngeal nerve is an effective treatment of patients with
glossopharyngeal neuralgia in whom compression of the nerve by a blood vessel is implicated in the pathogenesis of the disease. The standard surgical technique uses a
binocular operating microscope for intra-operative visualization. Growing experience with posterior fossa endoscopy, however, has suggested that
endoscopes may provide more comprehensive anatomical views of cerebellopontine angle. This report describes the case of a patient suffering from
glossopharyngeal neuralgia who underwent fully endoscopic vascular
decompression of the glossopharyngeal nerve. During this procedure the
endoscope was used to survey the posterior fossa, guide the placement of insulating sponges, and conduct a final assessment of the intervention. We found the
endoscope ideally suited to the constricted operating space of the posterior fossa, allowing for accurate localization and careful separation of the pathological vascular conflict with minimal brain retraction and no damage to surrounding structures. The versatility of endoscopy allows for superior visual appreciation of neurovascular conflicts in the posterior fossa. To date, endoscopy has primarily been used to supplement microscopy in cranial nerve
decompression surgery. This report demonstrates how the
endoscope can be used as the sole imaging modality in glossopharyngeal nerve
decompression, with excellent results.