椎动脉优势和基底动脉弯曲与后循环梗死部位的关系

目的 探讨椎动脉优势、基底动脉弯曲与后循环梗死的关系,分析后循环不同部位梗死患 者的椎动脉优势与基底动脉弯曲的关系。方法 选取临床表现为后循环梗死、头晕和眩晕、头痛等症状 患者156例,根据MRA检查结果分成椎动脉优势组（86例）及非优势组（70例）。比较两组间后循环各部位 的梗死发生率以及基底动脉弯曲的发生率,分析优势组各梗死部位后循环梗死侧与椎动脉优势侧的关 系,基底动脉弯曲方向与椎动脉优势侧相关性,基底动脉弯曲与后循环梗死的相关性。结果 85.1%（40/47） 基底动脉弯曲向椎动脉优势对侧,基底动脉弯曲方向与椎动脉优势方向呈负相关（r=-0.704,P ＜ 0.01）,优 势组后循环梗死的发生率明显高于对照组［51.2%（ 44/86） 比22.9%（ 16/70）,χ2=13.063,P＜0.01］。两组 间在小脑后下动脉（PICA）区和基底动脉（BA）区梗死发生率差异均有统计学意义,其余部位两组间的发 生率差异无统计学意义。基底动脉弯曲患者在PICA区和BA区梗死发生率与基底动脉呈直线患者差异 均有统计学意义,其余部位梗死的发生率差异无统计学意义。结论 椎动脉优势易于导致基底动脉弯曲 的发生,基底动脉易向优势对侧发生弯曲。椎动脉优势容易发生PICA供血区及BA脑桥支供血区的梗死, PICA供血区梗死部位多发生在椎动脉优势对侧,基底动脉弯曲侧;而BA脑桥支供血区的梗死多发生在 椎动脉优势侧,即基底动脉弯曲的对侧。     

椎动脉优势与后循环梗死的关系

目的 探讨椎动脉优势(vertebral artery dominance)与后循环梗死发生率及梗死侧的关系.同时了解椎动脉优势与基底动脉弯曲的相关性.方法 134例缺血性脑血管疾病、脑出血及突发性耳聋患者根据其是否存在椎动脉优势分为有椎动脉优势68例(优势组)和无椎动脉优势66例(对照组).比较两组间后循环梗死总发生率,后循环各部位的梗死发生率以及基底动脉弯曲的发生率.统计优势组各梗死部位后循环梗死侧与椎动脉优势侧的相关性,基底动脉弯曲方向与椎动脉优势侧的相关性,基底动脉弯曲与否与后循环梗死的相关性.结果 优势组后循环梗死发生率高于对照组[45.6％ (31/68)与21.2％(14/66),x2=8.922,P=0.003].优势组小脑后下动脉(PICA)供血区梗死及基底动脉供血区梗死发生率显著高于对照组[11.8％ (8/68)与0,x2=8.250,P=0.004;20.6％(14/68)与7.6％ (5/66),x2=4.660,P =0.031];两组的小脑上动脉供血区梗死率及大脑后动脉供血区梗死率差异无统计学意义.7例(7/8) PICA梗死患者梗死侧在椎动脉优势对侧.6例(6/14)基底动脉区梗死患者梗死侧与优势侧同侧.优势组基底动脉弯曲发生率显著高于对照组[50.0％(34/68)与9.1％ (6/66),x2=26.768,P=0.000].优势组基底动脉弯曲患者后循环梗死发生率与基底动脉呈直线的患者相仿,差异无统计学意义[ 52.9％ (18/34)与38.2％ (13/34),x2=1.482,P=0.223].优势组34例基底动脉弯曲的患者中,97.1％ (33/34)弯曲向椎动脉优势对侧.结论 椎动脉优势的患者较易发生后循环梗死,尤其是PICA和基底动脉供血区梗死,PICA供血区梗死部位一般在椎动脉优势对侧.椎动脉优势患者易致基底动脉弯曲,基底动脉一般弯向椎动脉优势对侧.     

椎动脉优势、基底动脉弯曲与经典三叉神经痛的相关性研究

目的探讨经典三叉神经痛(CTN)与椎动脉优势(VAD)的之间的关系。方法收集384例CTN患者和384例非三叉神经痛(N-CTN)患者的临床资料,并根据Frighetto的标准评价CTN患者的症状评分;测量两侧椎动脉直径以及基底动脉弯曲长度(BL),分析CTN与VAD的发生率、疼痛程度及发生侧别的关系。结果 VAD的发生率在CTN组(61.46%)和N-CTN组(49.74%)比较具有统计学差异(P0.05);CTN组右侧疼痛的发生率高于左侧,VAD左侧优势的比率在CTN组和N-CTN组中均明显高于右侧;CTN组VAD亚组基底动脉弯曲的发生率为75.42%,BL长度为(3.72±1.47)mm,N-CTN组VAD亚组为59.68%、(2.39±1.08)mm,两组比较差异均具有统计学意义(均P0.05)。427例VAD患者中,基底动脉弯曲292例,基底动脉弯曲方向发生在优势侧对侧共计246例,占84.25%。在不同级别椎动脉直径差异中,CTN患者症状评分各组间比较差异具有统计学意义(均P0.05);在不同级别基底动脉弯曲中,CTN患者症状评分各组间比较差异具有统计学意义(均P0.05)。CTN评分与椎动脉直径差异呈正相关(r=0.341,P=0.001),与BL呈正相关(r=0.134,P=0.001)。结论 CTN患者VAD发生率较N-CTN人群高,其疼痛侧别多见于VAD对侧;VAD直径差异越大,基底动脉弯曲程度越大,CTN患者症状评分越高。     

椎动脉优势与后循环脑梗死复发的相关性

目的探讨椎动脉优势(VAD)与后循环脑梗死复发的相关性。方法对116例后循环脑梗死患者进行MRA检查,根据结果分为VAD组与非VAD组。比较两组椎动脉(VA)、基底动脉(BA)的收缩期血流速度(Vs)、搏动指数(PI)。随访12个月,比较两组后循环脑梗死复发率及梗死灶分布情况的差异。结果根据MRA检查结果,116例患者分为VAD组(72例),非VAD组(44例)。VAD组优势侧VA的Vs高于,PI低于非优势侧VA(均P0.05);非VAD组双侧VA的Vs低于VAD组优势侧VA,但高于VAD组非优势侧VA(均P0.05);非VAD组双侧VA的PI低于VAD组非优势侧VA(均P0.05)。VAD组BA的PI高于非VAD组(P0.05)。VAD组复发率(25.0%)明显高于非VAD组(9.1%)(χ2=4.498,P=0.034)。VAD组复发的脑梗死病灶在小脑后下动脉供血区域者7例,非VAD组则为0例,两组间差异有统计学意义(P0.05)。结论存在VAD现象时,非优势侧VA的Vs下降,非优势侧VA及BA的PI值升高,后循环脑梗死复发率升高,且复发的脑梗死更易出现小脑下后动脉供血区。VAD现象可作为后循环脑梗死复发的预测指标。     

椎动脉发育不良患者对侧椎动脉和基底动脉病变的特点

目的探讨椎动脉发育不良(VAH)患者对侧椎动脉和基底动脉病变的特点。方法连续入组我院2014年12月至2018年2月首次发作且有完整的颅内外超声血管评估的急性脑梗死患者。采用超声筛查VAH(V2段2.5 mm)及血管狭窄并经头颈部CTA、MRA或DSA确认,且排除椎动脉夹层对VAH诊断的干扰。比较在前循环和后循环梗死中VAH的发生率。在后循环梗死患者中,分析存在VAH的患者对侧椎动脉、基底动脉、Willis环的情况。结果共入组750例患者,男性436例(58%),女性314例(42%);年龄18～90岁,平均65岁。后循环梗死193例(25.7%),前循环梗死557例(74.3%),在后循环梗死中检出VAH的比率高(33.7%VS 14.1%,P0.01)。吸烟是VAH合并后循环梗死的独立危险因素(OR=2.767,95%CI:1.45～5.08,P0.05)。VAH并后循环梗死患者的基底动脉狭窄(OR=2.07,95%CI:1.00～4.26,P0.05)、对侧椎动脉狭窄(OR=3.22,95%CI:1.24～8.37,P0.05)、以及胚胎型大脑后动脉(OR=2.17,95%CI:1.00～4.68,P0.05)的发生率明显高于非VAH组。结论后循环梗死患者中VAH的发生率高;VAH合并后循环梗死患者对侧椎动脉狭窄和基底动脉狭窄的频率较高。     

伴有椎动脉优势的后循环梗死的血流动力学研究

目的 观察伴有椎动脉优势（VAD）的后循环梗死患者的血流动力学变化。方法 将临床 表现为后循环梗死、头晕和眩晕、头痛等症状共156 例患者,根据头颅MRA 椎动脉优势评判标准分为伴 VAD 组（86 例）和不伴VAD 组（70 例）,通过TCD 观察每组后循环供血动脉的血流动力学变化。结果 伴 VAD 组优势侧椎动脉Vs、Vd、Vm值高于非优势侧,也高于不伴VAD 组（P ＜ 0.05）。伴VAD 组基底动 脉Vd 和Vm 值低于不伴VAD 组（P ＜ 0.05）,PI 和RI 高于不伴VAD 组（P＜ 0.05）。两组大脑后动脉的Vs、 Vd、Vm、PI、RI 值比较差异均无统计学意义（P＞ 0.05）,伴VAD 组出现频谱形态异常。结论 伴VAD 患 者出现脑血流动力学改变,优势侧椎动脉血流速度增快,基底动脉血流速度减慢,可能是造成后循环梗 死的原因之一。     

椎动脉优势对基底动脉弯曲及椎基底动脉连接部脑梗死的影响

目的 探讨椎动脉优势对基底动脉弯曲及椎基底动脉连接部脑桥和小脑梗死的影响. 方法 回顾性分析郑州人民医院神经内三科自2009年1月至2011年1月收治的91例单侧脑桥或小脑后下动脉脑梗死患者的影像学资料,包括梗死侧别、椎动脉优势、基底动脉弯曲及其方向性关系等,应用多元logistic回归分析寻找基底动脉弯曲的预测因素. 结果 旁正中动脉供血区的脑桥中央是脑桥梗死最多的受累部位,右侧小脑内下部是小脑后下动脉梗死最多的受累部位.椎动脉优势常发生于左侧(69.2％,63/91).91例患者中有76例在椎动脉优势和基底动脉弯曲之间存在相反方向的关系.椎动脉内径是基底动脉中重度弯曲的唯一预测因素,其OR值为2.70,95％CI为1.22～5.98. 结论 椎动脉优势是基底动脉弯曲的重要预测因素,且弯曲多朝向优势椎动脉的对侧.椎动脉优势及其造成的基底动脉弯曲增加了椎基底动脉连接部脑梗死的发生率.     

脑干梗死的危险因素分析

目的探讨脑干梗死的危险因素。方法根据脑梗死部位将193例脑梗死患者分为大脑半球梗死组(128例)和脑干梗死组(65例),比较两组间性别、年龄、吸烟、合并症、血脂及糖化血红蛋白(HbA1c)水平,以及两组患者基底动脉和椎动脉狭窄度、基底动脉弯曲分级、椎动脉优势的比率;采用Logistic回归方法分析脑干梗死危险因素。结果与大脑半球梗死组比较,脑干梗死组年龄明显降低,吸烟、合并糖尿病的比率明显增高,血低密度脂蛋白及HbA1c水平明显增高(P<0.05～0.01);基底动脉和椎动脉狭窄率、基底动脉弯曲≥2级率及椎动脉优势比率明显增高(P<0.05～0.01)。Logistic多因素回归分析显示,伴有糖尿病(OR=4.018,95%CI:1.796～8.992;P=0.0006)、基底动脉狭窄(OR=1.003,95%CI:1.018～1.048;P<0.0001)和基底动脉弯曲≥2级(OR=1.377,95%CI:1.008～1.059;P=0.0087)与脑干梗死的发生独立相关。结论伴有糖尿病、基底动脉狭窄和基底动脉弯曲度是脑干梗死的重要的高危因素。     

双侧小脑梗死模式的探讨

目的探寻双侧小脑梗死的模式和机制。方法经MRI弥散成像(DWI)证实急性期小脑梗死的患者,根据梗死灶的分布将患者分为单侧小脑梗死组(UCI)和双侧小脑梗死组(BCI),并对两组的人口学特征、血管分布、小脑以外梗死灶以及病因进行了比较。结果因急性卒中入院的115例后循环脑梗死患者中,56例为小脑梗死或小脑合并其它部位梗死,其中单侧小脑梗死36例(64.3%),双侧小脑梗死20例(35.7%)。基线资料比较显示,脑卒中史(P=0.002)、纤维蛋白元水平(P=0.036)和入院时NIHSS评分(P=0.001)在双侧小脑梗死组明显高于单侧小脑梗死组。按血管分布区划分,小脑后下动脉(PICA)供血区小脑梗死发生率最高,且更多发生单侧小脑梗死(P=0.006);而双侧小脑梗死更常见于PICA+小脑上动脉(SCA)供血区(P=0.004)。双侧小脑梗死组合并小脑以外梗死灶的发生率明显高于单侧小脑梗死组(P=0.002),特别是合并幕下梗死灶常见(P=0.022)。在卒中机制上,双侧小脑梗死以大动脉粥样硬化性病变更多见(P=0.041),责任动脉病变主要是在椎动脉V4段、V4段与BA接合处的重度狭窄或闭塞。结论双侧小脑梗死并不少见,常见于PICA+SCA供血区;大动脉粥样硬化所致动脉源性栓塞是其卒中重要机制之一。     

LVIS支架在PICA起始部、基底动脉夹层动脉瘤中的应用

目的探讨LVIS支架治疗椎动脉小脑下后动脉(PICA)起始部、基底动脉夹层动脉瘤的疗效。方法回顾性分析29例夹层动脉瘤病人的临床资料,动脉瘤位于椎动脉PICA起始部(椎动脉组)14例,基底动脉(基底动脉组)15例。栓塞结果依据Raymond分级评估,临床结果依据mRS评分评价。分析围手术期并发症及随访结果。结果动脉瘤完全栓塞5例,部分栓塞24例。椎动脉组和基底动脉组发生并发症各2、5例,其中死亡各1、2例,两组并发症发生率差异无统计学意义(P=0.390)。26例通过DSA检查及术后随访5~25个月,椎动脉组无进展病例,基底动脉组进展5例,差异显著(P=0.039);椎动脉组mRS评分预后良好12例,基底动脉组8例,预后良好率无明显差异(P=0.077)。结论基底动脉夹层动脉瘤容易进展,要严格随访,更有效的治疗方式需进一步探讨。     

Neuroendoscopy in microvascular decompression for trigeminal neuralgia and hemifacial spasm: technical note

Miocrovascular decompression is an effective treatment for trigeminal neuralgia (TN) and hemifacial spasm (HFS). A complete cure cannot be obtained, and additional adjuncts for extended use of endoscopy are needed. The use of an endoscope combined with the operating microscope can enhance the surgeon's ability to view deep structures during operation. We study the application of combined microsurgical and endoscopic techniques in 21 cases of HFS and 12 cases of TN. With these techniques the surgeon can explore the ventral aspect of the brainstem and cranial nerves without further retraction, can see the groove caused by compression of the offending artery, and can confirm the proper position of the prosthesis after attachment to the dura by fibrin glue. In HFS the most common offending vessels in 75% of cases were the posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA) and in 25% of cases the vertebral artery (VA). In trigeminal neuralgia the offending vessel in 60% of cases was the superior cerebellar artery (SCA), and in 40% of cases the AICA. The overall success rate was 97% with minimal morbidity 3% (facial palsy) and no mortality. The aim of this work is to study advantages and disadvantages of using endoscopy during microvascular decompression for TN and HFS.     

Characteristics of vascular lesions in patients with posterior circulation infarction according to age and region of infarct

Patients with posterior circulation infarction underwent CT angiography and magnetic resonance angiography. Intracranial and extracranial vasculopathy was evaluated according to age group and location of stroke. Patients aged > 60 years and < 60 years had similar rates of vertebral artery dominance and vertebrobasilar artery developmental or origin anomalies. Vertebrobasilar artery stenosis or occlusion and tortuosity occurred more frequently in patients aged > 60 years than < 60 years. The rates of vertebrobasilar artery anomalies and tortuosity were high in patients with posterior circulation infarction. Vertebrobasilar artery tortuosity occurred more frequently in patients aged > 60 years, whereas vertebrobasilar artery developmental anomalies occurred with similar frequency in patients aged < 60 years and > 60 years. Patients with infarction of the brainstem or cerebellum were more likely to have vertebral artery stenosis or occlusion, basilar artery stenosis or occlusion, vertebral artery dominance or tortuosity, and basilar artery tortuosity, and patients with infarction of the thalamus, medial temporal, or occipital lobes were more likely to have stenosis or occlusion of the vertebral or basilar arteries. Vertebrobasilar artery tortuosity, vertebral artery dominance (hypoplasia), and congenital variations of the vertebrobasilar system may lead to posterior circulation infarction at different locations in different age groups.     

Neuroendoscopy in microvascular decompression for trigeminal neuralgia and hemifacial spasm: Technical note

Abstract

Miocrovascular decompression is an effective treatment for trigeminal neuralgia (TN) and hemifacial spasm (HFS). A complete cure cannot be obtained, and additional adjuncts for extended use of endoscopy are needed. The use of an endoscope combined with the operating microscope can enhance the surgeon’s ability to view deep structures during operation. We study the application of combined microsurgical and endoscopic techniques in 21 cases of HFS and 12 cases of TN. With these techniques the surgeon can explore the ventral aspect of the brainstem and cranial nerves without further retraction, can see the groove caused by compression of the offending artery, and can confirm the proper position of the prosthesis after attachment to the dura by fibrin glue. In HFS the most common offending vessels in 75% of cases were the posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA) and in 25% of cases the vertebral artery (VA). In trigeminal neuralgia the offending vessel in 60% of cases was the superior cerebellar artery (SCA), and in 40% of cases the AICA. The overall success rate was 97% with minimal morbidity 3% (facial palsy) and no mortality. The aim of this work is to study advantages and disadvantages of using endoscopy during microvascular decompression for TN and HFS. [Neural Res 2000; 22: 522-526]     

小脑梗死的分型与后循环血管病变

目的 研究有无大血管病变患者小脑梗死灶的特征,探讨小脑梗死分型与后循环血管病变的关系。 方法 收集我科自2006年1月～2008年3月期间住院的小脑梗死患者共35例,所有患者均同时具备颅脑磁共振成像（magnetic resonance imaging,MRI）和血管造影检查,包括计算机断层摄影血管造影（computed tomographic angiography,CTA）、磁共振血管造影（magnetic resonance angiography,MRA）和数字减影血管造影（digital subtraction angiography,DSA）检查。根据血管造影检查的结果将入组患者分为两组：大血管病变组20例,小血管病变组15例,分析两组小脑梗死的分型和后循环血管病变（包括狭窄或闭塞）的关系。 结果 ⑴大血管病变组20例中,颅内血管（椎动脉颅内段或基底动脉）病变最多见（10例,50%）,梗死类型多为分水岭梗死（7例,70%）;其次为颅外血管合并颅内血管（椎动脉颅外段合并颅内段或基底动脉）病变（8例,40%）,梗死灶多为小脑后下动脉（PICA）供血区的区域性梗死（7例,87.5%）;单独颅外血管（椎动脉颅外段）病变最少见（2例,10%）,梗死分布无明显倾向性。⑵小血管病变组15例中,梗死灶亦多位于分水岭区（9例,60%）。 结论 由于小脑血液供应特点,小脑梗死中分水岭梗死和腔隙性梗死较区域性梗死更为常见。小梗死灶（直径≤2cm）可能存在后循环大血管的狭窄或闭塞,应予积极的治疗和干预,以防病情加重。     

左侧三叉神经痛、面肌痉挛、原发性高血压共同发生一例报告并文献复习

目的探讨左侧三叉神经痛、面肌痉挛、原发性高血压三者共同发生的发病机制、治疗和预后。方法手术治疗1例左侧三叉神经痛、面肌痉挛、原发性高血压共同发生的男性患者，并结合文献进行分析。结果此病例左三叉神经痛、面肌痉挛、原发性高血压与扩张迂曲椎一基底动脉压迫之间存在因果关系，行显微血管减压术后病人三叉神经痛、面肌痉挛消失，血压正常，无并发症。结论左三叉神经痛、面肌痉挛、原发性高血压三者共同发生患者少见，其与血管压迫之间存在因果关系，血管减压术是有效的治疗方法。     

后循环动脉瘤显微外科手术治疗

目的 探讨后循环动脉瘤手术适应证和治疗效果.方法 纳入42例共44个后循环动脉瘤,包括基底动脉动脉瘤26例(27个)、椎动脉动脉瘤16例(17个).其中15例分别行颈外动脉-大脑后动脉P2段(4例)、颈内动脉-大脑后动脉P2段(2例)、颌内动脉-大脑后动脉P2段(2例)、椎动脉颅内外段(2例)、枕动脉.小脑后下小动脉(5例)搭桥联合动脉瘤孤立术;余27例行单纯动脉瘤夹闭术.结果 经随访共37例(基底动脉顶端动脉瘤14例、基底动脉主干动脉瘤3例、椎动脉动脉瘤9例、小脑后下动脉动脉瘤5例、大脑后动脉P1～P2段交界处动脉瘤4例、小脑上动脉动脉瘤l例和小脑前下动脉动脉瘤1例)患者恢复正常生活活动能力,无一例发生手术相关性神经功能障碍,恢复良好率达88.09%.其余5例患者,1例(基底动脉顶端动脉瘤)术后出现严重神经功能缺损症状与体征,生活不能自理;2例(1例基底动脉顶端动脉瘤、1例基底动脉主干动脉瘤)因术后发生脑干缺血,围手术期死亡;2例(椎动脉动脉瘤)复发患者经再次治疗康复.结论 对于不宜直接行手术夹闭的后循环动脉瘤,为了避免因夹闭动脉瘤和延长临时阻断载瘤动脉时间而发生术后脑缺血事件.可选择颅内外血管搭桥联合动脉瘤孤立术,以避免动脉瘤夹闭术带来的危险.     

Facial hemispasm and anomalies of the terminal portion of the vertebral artery (author's transl)]

A revision is suggested of the concept of "essential hemifacial spasm": 23 cases have been studied in whom the facial spasm was the only symptom present, while in 8 other cases in addition to the spasm of facial muscles other symptoms were noticed suggesting a pathology of the ponto-cerebellar angle. In many cases the symptom "spasm" and other concomitant symptoms are a direct consequence of an irritation due to compression on the nerve root (and/or on other nervous structures) owing to stretch of the distal tract of the vertebral artery or of the initial segment of the basilar artery. In five cases the AA. studied the vertebro-basilar circulation and in four patients they have actually found pathological elongations of the great vessels. In 18 other cases it was only possible to assume the presence of analogous alterations. The AA. suggest a study of the vertebro-basilar circulation in all the patients with "essential hemifacial spasm".     

显微血管减压术治疗多根颅神经疾患

目地探讨显微血管减压术治疗同一病人并存多根颅神经疾患病例的疗效。方法采用显微血管减压术治疗同一病人并存多根颅神经疾患病例。包括同侧三叉神经痛合并舌咽神经痛12例,同侧三叉神经痛合并面肌痉挛3例,同侧舌咽神经痛合并面肌痉挛2例,双侧三叉神经痛3例,双侧面肌痉挛2例,双侧舌咽神经痛1例。结果术后总有效率100%,治愈率97.83%(45/46),平均随访30.57个月,治愈率97.83%(45/46),仅1例次三叉神经痛复发,再次手术后治愈。结论显微血管减压术是治疗同一病人并存多根颅神经疾患病例安全有效的显微外科手术方法。     

Lipoma Causing Glossopharyngeal Neuralgia: A Case Report and Review of Literature

The cerebello-pontine angle lipomas causing trigeminal neuralgia or hemifacial spasm are rare. A lipoma causing glossopharyngel neuralgia is also very rare. A 46-year-old woman complained of 2-year history of severe right throat pain, with ipsilateral episodic otalgic pain. The throat pain was described as an episodic lancinating character confined to the throat. Computed tomography and magnetic resonance imaging revealed a suspicious offending posterior inferior cerebellar artery (PICA) compressing lower cranial nerves including glossopharyngeal nerve. At surgery, a soft, yellowish mass (2×3×3 mm in size) was found incorporating the lateral aspect of proximal portion of 9th and 10th cranial nerves. Only microvascular decompression of the offending PICA was performed. Additional procedure was not performed. Her severe lancinating pain remained unchanged, immediate postoperatively. The neuralgic pain disappeared over a period of several weeks. In this particular patient with a fatty neurovascular lump causing glossopharyngeal neuralgia, microvascular decompression of offending vessel alone was enough to control the neuralgic pain.