Geniculate Neuralgia
Geniculate neuralgia (GN), also known as nervus intermedius neuralgia, is a rare craniofacial pain syndrome characterized by severe, paroxysmal, stabbing pain in the ear canal.
Anatomy
The nervus intermedius, a branch of the facial nerve (cranial nerve VII), is primarily implicated in GN. It carries sensory fibers from the ear canal and tympanic membrane.
Pathophysiology
The exact cause of GN is not fully understood, but it is often attributed to neurovascular compression of the nervus intermedius by vessels such as the anterior inferior cerebellar artery. Other etiologies include nerve inflammation or irritation.[1][2][3]
Clinical Features
Patients typically present with severe, intermittent, stabbing pain localized to the ear canal. The pain may radiate to the auricle, mastoid, soft palate, temple, and angle of the jaw. It can be triggered by stimulation of the external ear and may be accompanied by facial pain.
Management
Medical Management: First-line treatment involves anticonvulsants such as carbamazepine or oxcarbazepine, similar to the management of trigeminal neuralgia.[4]
Surgical Management: When medical therapy fails, surgical options include:
Nervus Intermedius Sectioning: This involves transecting the nervus intermedius to relieve pain. Studies have shown favorable outcomes with this approach.[5]
Microvascular Decompression (MVD): This procedure involves decompressing the nervus intermedius at the root entry zone to alleviate neurovascular compression. MVD can be performed alone or in combination with nervus intermedius sectioning.[6]
Surgical interventions have shown high success rates in pain relief, with a low incidence of complications. Further research is needed to refine treatment guidelines and clarify the specific role of nervus intermedius in otalgia
References
- ā Peris-Celda, Maria; Oushy, Soliman; Perry, Avital; Graffeo, Christopher S.; Carlstrom, Lucas P.; Zimmerman, Richard S.; Meyer, Fredric B.; Pollock, Bruce E.; Link, Michael J. (2019-08). "Nervus intermedius and the surgical management of geniculate neuralgia". Journal of Neurosurgery. 131 (2): 343ā351. doi:10.3171/2018.3.JNS172920. ISSN 0022-3085. Check date values in:
|date=(help) - ā George, Derek D.; Ridder, Thomas S. (2020-08). "Geniculate neuralgia in an adolescent treated via sectioning of the nervus intermedius and microvascular decompression". Journal of Neurosurgery: Pediatrics. 26 (2): 189ā192. doi:10.3171/2020.3.PEDS19584. ISSN 1933-0707. Check date values in:
|date=(help) - ā Clifton, William E.; Grewal, Sanjeet; Lundy, Larry; Cheshire, William P.; Tubbs, R. Shane; Wharen, Robert E. (2020-10). "Clinical implications of nervus intermedius variants in patients with geniculate neuralgia: Let anatomy be the guide". Clinical Anatomy (in English). 33 (7): 1056ā1061. doi:10.1002/ca.23536. ISSN 0897-3806. Check date values in:
|date=(help) - ā Robblee, Jennifer (2025-12). "Nervus Intermedius Neuralgia". Current Pain and Headache Reports (in English). 29 (1): 32. doi:10.1007/s11916-024-01335-2. ISSN 1531-3433. Check date values in:
|date=(help) - ā Ren, Alexander L.; Ehsani, Amirreza; Park, David J.; Persad, Amit R.; Wu, Janet Y.; Hall, Jennifer C.; Zhang, Michael; Choi, John; Kim, Lily H.; Xu, Risheng; Chang, Steven D. (2025-03-01). "Nervus intermedius sectioning for the treatment of geniculate neuralgia". Journal of Neurosurgery: 1ā8. doi:10.3171/2024.11.JNS241141. ISSN 0022-3085.
- ā Tubbs, R. Shane; Mosier, Kristine M.; Cohen-Gadol, Aaron A. (2013-12). "Geniculate Neuralgia: Clinical, Radiologic, and Intraoperative Correlates". World Neurosurgery (in English). 80 (6): e353āe357. doi:10.1016/j.wneu.2012.11.053. Check date values in:
|date=(help)
