J Neurosurg 143:111–118, 2025
Nervus intermedius (NI) sectioning for geniculate neuralgia (GN) provided pain relief in 81% and complete resolution in 68% of cases, with low complication rates. Combining NI sectioning with microvascular decompression improved outcomes. The study supports NI sectioning as a safe, effective surgical option when medical management fails.
• Geniculate neuralgia (GN) is a rare facial pain syndrome with severe stabbing ear pain, often involving the nervus intermedius (NI) as the primary structure.
• Medical management is first-line, but when ineffective, surgical options like NI sectioning and microvascular decompression (MVD) are considered.
• This study presents the largest case series (47 procedures in 45 patients) of NI sectioning for GN, with most patients also having trigeminal neuralgia or glossopharyngeal neuralgia.
• NI sectioning led to pain improvement (BNI score < IV) in 80.9% and complete pain resolution (BNI I) in 68.1% of procedures at latest follow-up.
• Combining NI sectioning with MVD further improved outcomes, especially in patients with concurrent neuralgias.
• Complications were rare: 2 cases of hearing loss, 1 confirmed permanent vestibular dysfunction, and 3 cases of loss of taste; no permanent facial paralysis or loss of lacrimation.
• Older age predicted worse pain outcomes after surgery.
• The study supports NI sectioning as a safe and effective treatment for GN, especially when tailored with MVD as needed.
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