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Geniculate neuralgia


Neurosurgery Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain

Geniculate neuralgia is a pain syndrome associated with the nervus intermedius.


Fewer than 150 reported cases were published in English between 1932 and 2012 1).


The etiology of the condition remains unknown 2).


Unilateral paroxysmal otalgia radiating to the auricle.

Ocassional burning sensations around the ipsilateral eye and cheek, and prosopalgia.

The pain may also be of gradual onset and of a dull, persistent nature, with occasional sharp, stabbing pain like an electric shock, deep in the ear 3).

Some people have reported additional symptoms during pain attacks:


Bitter taste




The clinical presentation varies. Non-neuralgic causes of otalgia should always be excluded by a thorough clinical examination, audiological assessment and radiological investigations before making a diagnosis of geniculate neuralgia 4).

Differential diagnosis

Due to the close anatomical proximity, temporomandibular joint (TMJ) pathologies should be included in the differential diagnosis.

Easily confused with trigeminal neuralgia and glossopharyngeal neuralgia. However, nerves intermedius has its characteristic clinical syndroms to be diagnosed.

see Ramsay Hunt syndrome.


Case series

Case reports


A case illustration was presented that demonstrates the novel brainstem functional imaging findings for geniculate neuralgia. A 39-year-old man presented with a history of left “deep” ear pain within his ear canal. He noted occasional pain on the left side of his face around the ear. He had been treated with neuropathic pain medications without relief. His wife described suicidal ideations discussed by her husband because of the intense pain.

The patient's neurologic examination was normal, and otolaryngologic consultation revealed no underlying structural disorder. Anatomic imaging revealed a tortuous vertebral artery-posterior inferior cerebellar artery complex with the posterior inferior cerebellar artery loop impinging on the root entry zone of the nervus intermedius-vestibulocochlear nerve complex and just inferior to the root entry zone of the facial nerve and a small anterior inferior cerebellar artery loop interposed between the cranial nerve VII-VIII complex and the hypoglossal and glossopharyngeal nerves. A left-sided retromastoid craniotomy was performed, and the nervus intermedius was transected. An arterial loop in contact with the lower cranial nerves at the level of the brainstem was mobilized with a polytetrafluoroethylene implant.

The patient indicated complete relief of his preoperative pain after surgery. He has remained pain-free with intact hearing and balance 5).


Figueiredo et al., present a case report of a female patient who was successfully managed with pharmacological treatment 6).


A patient had combined otalgia and intractable unilateral facial spasm, relieved by microsurgical vascular decompression of the seventh and eighth cranial nerve complex in the cerebellopontine angle without section of the intermediate nerve. A dolicho-ectatic anterior inferior cerebellar artery compressed the seventh and eighth cranial nerves complex, suggesting that vascular compression of the intermediate nerve or of the sensory portion of the facial nerve may cause geniculate neuralgia. “Tic convulsif” seems to be a combination of geniculate neuralgia and hemifacial spasm. This combination could be due to vascular compression of the sensory and motor components of the facial nerve at their junction with the brainstem 7).

1) , 2) , 4)
Tang IP, Freeman SR, Kontorinis G, Tang MY, Rutherford SA, King AT, Lloyd SK. Geniculate neuralgia: a systematic review. J Laryngol Otol. 2014 May;128(5):394-9. doi: 10.1017/S0022215114000802. Review. PubMed PMID: 24819337.
Pulec JL. Geniculate neuralgia: diagnosis and surgical management. Laryngoscope. 1976 Jul;86(7):955-64. PubMed PMID: 933690.
Tubbs RS, Mosier KM, Cohen-Gadol AA. Geniculate neuralgia: clinical, radiologic, and intraoperative correlates. World Neurosurg. 2013 Dec;80(6):e353-7. doi: 10.1016/j.wneu.2012.11.053. PubMed PMID: 23178920.
Figueiredo R, Vazquez-Delgado E, Okeson JP, Gay-Escoda C. Nervus intermedius neuralgia: a case report. Cranio. 2007 Jul;25(3):213-7. Review. PubMed PMID: 17696039.
Yeh HS, Tew JM Jr. Tic convulsif, the combination of geniculate neuralgia and hemifacial spasm relieved by vascular decompression. Neurology. 1984 May;34(5):682-3. PubMed PMID: 6538661.
geniculate_neuralgia.txt · Last modified: 2018/09/18 12:20 by administrador