• Keisuke Onoda, Ai Kawaguchi, Yoshinori Takaya, Yuzo Saito, Hisashi Ishikawa, Takeshi Uno, Michiyuki Miyamoto, Kenichi Oyama, and Akira Matsuno.
• Department of Neurosurgery, Teikyo University Medical School, Itabashi-ku, Tokyo, Japan. Electronic address: onoda3883@gmail.com.
• World Neurosurg. 2020 May 1; 137: 89-92.

BackgroundNervus intermedius neuralgia is an extremely rare craniofacial neuralgia characterized by paroxysmal episodes of pain located deep in the ear, typically triggered by sensory or mechanical stimuli at the wall of the auditory canal without underlying pathology. Pain is sometimes associated with disorders of lacrimation, salivation, and taste.Case DescriptionWe present a case of a surgically treated 68-year-old man with left paroxysmal deep ear pain for 20 years before presentation. Preoperative 3-dimensional magnetic resonance cisternography/magnetic resonance angiography (3D-MRC/MRA) fusion imaging showed severe compression of the facial nerve by the anterior inferior cerebellar artery in the cisternal portion with associated nerve deformity. We suspected nervus intermedius neuralgia and decided to perform microvascular decompression of the facial nerve. Transposition of the artery led to sufficient decompression of the nerve. The pain disappeared immediately after surgery.ConclusionsIt is important to keep in mind the possibility of nervus intermedius neuralgia in patients who present with intermittent episodes of pain located deep in the ear. Furthermore, 3D-MRC/MRA fusion imaging is useful for decision-making in surgery. Microvascular decompression was highly effective in our case. Based on radiological findings, microvascular decompression should be considered a viable treatment option.Copyright © 2020 Elsevier Inc. All rights reserved.

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