Abstract：
BACKGROUND: Nervus intermedius neuralgia (NIN) is characterized by paroxysmal episodes of sharp, lancinating pain in the deep ear. Unfortunately, only a few studies exist in the literature on this pain syndrome, its pathology and postoperative outcomes.
METHODS: We conducted a retrospective review of four cases diagnosed with NIN who underwent a neurosurgical intervention at our center from January 2015 to January 2023. Detailed information on their MRI examinations, intraoperative findings and other clinical presentations were obtained, and the glossopharyngeal and vagus nerves were isolated for immunohistochemistry examination.
RESULTS: A total of 4 NIN patients who underwent a microsurgical intervention at our institution were included in this report. The NI was sectioned in all patients and 3 of them underwent a microvascular decompression. Of these 4 patients, 1 had a concomitant trigeminal neuralgia (TN), and 1 a concomitant glossopharyngeal neuralgia (GPN). Three patients underwent treatment for TN and 2 for GPN. Follow-up assessments ranged from 8 to 99 months. Three patients reported complete pain relief immediately after the surgery until last follow-up, while in the remaining patient the preoperative pain gradually resolved over the 3 month period. Immunohistochemistry revealed that a greater amount of CD4+ and CD8+ T cells had infiltrated the glossopharyngeal versus vagus nerve.
CONCLUSIONS: NIN is an extremely rare condition showing a high degree of overlap with TN/GPN. An in depth neurosurgical intervention is effective to completely relieve NIN pain, without any serious complications. It appears that T cells may play regulatory role in the pathophysiology of CN neuralgia.
METHODS: We conducted a retrospective review of four cases diagnosed with NIN who underwent a neurosurgical intervention at our center from January 2015 to January 2023. Detailed information on their MRI examinations, intraoperative findings and other clinical presentations were obtained, and the glossopharyngeal and vagus nerves were isolated for immunohistochemistry examination.
RESULTS: A total of 4 NIN patients who underwent a microsurgical intervention at our institution were included in this report. The NI was sectioned in all patients and 3 of them underwent a microvascular decompression. Of these 4 patients, 1 had a concomitant trigeminal neuralgia (TN), and 1 a concomitant glossopharyngeal neuralgia (GPN). Three patients underwent treatment for TN and 2 for GPN. Follow-up assessments ranged from 8 to 99 months. Three patients reported complete pain relief immediately after the surgery until last follow-up, while in the remaining patient the preoperative pain gradually resolved over the 3 month period. Immunohistochemistry revealed that a greater amount of CD4+ and CD8+ T cells had infiltrated the glossopharyngeal versus vagus nerve.
CONCLUSIONS: NIN is an extremely rare condition showing a high degree of overlap with TN/GPN. An in depth neurosurgical intervention is effective to completely relieve NIN pain, without any serious complications. It appears that T cells may play regulatory role in the pathophysiology of CN neuralgia.
摘要：
背景：中间神经痛（NIN）的特征是尖锐的阵发性发作，耳朵深处刺痛。不幸的是,关于这种疼痛综合征的文献中只有少数研究，其病理和术后结果。
方法：我们对2015年1月至2023年1月在我们中心接受神经外科手术治疗的4例NIN患者进行了回顾性回顾。他们MRI检查的详细信息,获得术中发现和其他临床表现，分离舌咽神经和迷走神经进行免疫组织化学检查。
结果：本报告共纳入4例NIN患者，这些患者在我院接受了显微外科手术。对所有患者进行NI切片，其中3例接受了微血管减压术。在这4名患者中,1患有伴随的三叉神经痛（TN），和1伴随舌咽神经痛（GPN）。3例接受TN治疗，2例接受GPN治疗。随访评估范围为8至99个月。三名患者在手术后立即报告疼痛完全缓解，直到最后一次随访。而其余患者的术前疼痛在3个月内逐渐缓解。免疫组织化学显示，更大量的CD4和CD8T细胞浸润了舌咽神经和迷走神经。
结论：NIN是一种非常罕见的疾病，与TN/GPN高度重叠。深入的神经外科干预可以有效地完全缓解NIN疼痛，没有任何严重的并发症。T细胞似乎在CN神经痛的病理生理中起调节作用。
方法：我们对2015年1月至2023年1月在我们中心接受神经外科手术治疗的4例NIN患者进行了回顾性回顾。他们MRI检查的详细信息,获得术中发现和其他临床表现，分离舌咽神经和迷走神经进行免疫组织化学检查。
结果：本报告共纳入4例NIN患者，这些患者在我院接受了显微外科手术。对所有患者进行NI切片，其中3例接受了微血管减压术。在这4名患者中,1患有伴随的三叉神经痛（TN），和1伴随舌咽神经痛（GPN）。3例接受TN治疗，2例接受GPN治疗。随访评估范围为8至99个月。三名患者在手术后立即报告疼痛完全缓解，直到最后一次随访。而其余患者的术前疼痛在3个月内逐渐缓解。免疫组织化学显示，更大量的CD4和CD8T细胞浸润了舌咽神经和迷走神经。
结论：NIN是一种非常罕见的疾病，与TN/GPN高度重叠。深入的神经外科干预可以有效地完全缓解NIN疼痛，没有任何严重的并发症。T细胞似乎在CN神经痛的病理生理中起调节作用。
