Concomitant, asynchronous and refractory trigeminal and glossopharyngeal neuralgia. Good response to surgical approach in one time

Microvascular decompression (MVD) surgery is the first choice treatment for refractory cranial neuralgia secondary to vascular compression. Simultaneous neuralgia of two cranial nerves is extremely rare. We describe a case of concomitant refractory trigeminal (TN) and glossopharyngeal (GN) neuralgia secondary to neurovascular crossover, treated surgically at the same time. 65-year-old woman with right TN (initially V2-V3) since 2004 with regular control with carboxamides. Seventeen years later, paroxysms worsened in V2-V3, also appearing in V1 and in the territory of the right glossopharyngeal nerve (right ear and tonsillar fossa when speaking and swallowing). Cerebral MRI showed significant arterial contact between the superior cerebellar artery (SCA) with the origin of the right V cranial nerve and the antero-inferior cerebellar artery (AICA) with the origin of the right lower CCNN. MVD of both cranial nerves was performed at the same surgical time by means of retrosigmoid craniectomy, releasing the V cranial nerve, in intimate contact with the SCA, and the IX cranial nerve in contact with the right AICA, interposing teflon between them. The patient had an immediate resolution of the trigeminal paroxysms and a dramatic improvement in intensity and frequency of glossopharyngeal paroxysms. Two years after the intervention, de-escalation of neuromodulator treatment continues with good response. MVD in simultaneous TN and GN is feasible and can offer a good post-surgical outcome.