1072 Microsurgical Treatment of Geniculate Neuralgia: Results From the Largest Surgical Series to Date, Consisting of 143 Operations Performed in 116 Patients Over 11 Years

INTRODUCTION: 180 surgical Geniculate Neuralgia (GN) cases & 10 series (9/10 only 3-18 patients) published. Four CN’s provide sensation to the ear. Nervus intermedius (NI) surgery alone has suboptimal outcome. METHODS: Prospective database GN microsurgery, 6/2012 – 4/2023, retrospectively analyzed. 143 operations in 116 patients. Pre-operative vocal cord (VC) & swallow evaluations, hearing testing, & neuro-otology evaluations. Retrosigmoid craniectomy (RSC), intra-operative ABR, & CN 7, 9, & 10 EMG monitoring. Microvascular decompression (MVD) CN’s 5,7,9 & 10 and 56/116 (48%) also with section NI. Evaluations, 3m, 1y, & annually. Pain relief for typical neuralgic pain (TNP) & atypical neuralgic pain (ATNP), 0-10 scale. RESULTS: Only TN more common than GN. Isolated GN rare (8/116 - 7%). Remaining 93%, with TN &/or GPN (dominantly 44%; minor component 49%). Eventually bilateral 40.5%. Median age, 41y (range, 10 – 80). F:M, 8.7:1. 89/143 (62%) initial operations, 54 re-explorations (38%) (45/54 initially elsewhere). Median follow up (FU), 13m (42% > 2 y & 25% > 3.5y). Overall, 72.9% & 52.7% with TNP pain-free (PF) short-term (ST) & LT FU, & 84.9% & 64.4% with ATNP =50% improved in ST & LT FU. MVD of CN’s 5,7,9, & 10 &section NI as first surgery, 80.7% & 69.2% TNP PF ST & LT FU, & 76.9% & 69.2% ATNP =50% improved in ST & LT FU. Surprisingly, 53.8% & 30.7% ATNP PF in ST & LT FU. Complication similar to TN and GPN MVD, exceptions of 23.8%/23.7% risk of temporary swallowing/VC dysfunction & temporary diplopia (7%). Only 1 & 3 patients had permanent swallowing dysfunction, & hoarseness, respectively. CONCLUSIONS: GN more common than thought, rarely occurs in isolation, eventually bilateral in 40.5%, more common in women. Excellent LT TNP & ATNP outcomes requires addressing 4 CN’s (5,7,9,10) & sectioning NI.