356 Nervus Intermedius Sectioning for the Treatment of Geniculate Neuralgia: A Single-Surgeon Case Series

INTRODUCTION: Geniculate neuralgia (GN) is a rare pain condition involving the nervus intermedius (NI), a branch of the facial nerve. The current standard for surgical intervention consists of a retrosigmoid craniotomy with sectioning of the NI. However, few case reports/series exist detailing the outcomes of GN surgical treatment. METHODS: We reviewed patient charts involving craniotomies for GN performed by a single surgeon between November 2020 and December 2022. RESULTS: Three patients underwent two craniotomies for GN. GN patients were largely female (91.30%) and White, non-Hispanic/Latino (78.26%). Nearly all GN patients had a concurrent diagnosis of trigeminal neuralgia (n = 22, 95.65%) and some also had a concurrent diagnosis of glossopharyngeal neuralgia (n = 9, 39.13%). Vascular contact with cranial nerves VII and VIII was reported in four procedures. 22 procedures (84.62%) resulted in profound pain relief, with BNI pain score decreasing from 5 to 1 between pre-op and latest follow-up. No patients experienced unexpected hearing loss compared to baseline at latest follow-up. One patient experienced facial paralysis on the side of surgery and two patients experienced some form of vestibular dysfunction at latest follow-up. Of 26 total procedures, 20 included NI sectioning. Initial craniotomies in which the NI was sectioned (n = 18) resolved GN pain 88.89% of the time whereas craniotomies without NI sectioning (n = 5) resolved GN pain 60% of the time. CONCLUSIONS: NI sectioning is an effective means of achieving GN pain relief. Post-operative complications including unexpected hearing loss, facial paralysis, and vestibular dysfunction were infrequently observed in our series.