Seven males and nine females with glossopharyngeal neuralgia were treated by microvascular decompression (MVD) over a 4-year period. Their ages ranged from 40 to 72 years (average, 54.7 years). The duration of pain ranged from 2 months to 13 years, and all except one patient had brief attacks of lancinating pain in the throat and/or ear. One patient reported dull, paroxysmal throat pain. At surgery, vascular compression of the 9th and 10th nerves at the root entry-exit zone was observed in all cases. The offending vessels were the posterior inferior cerebellar artery (PICA) in 11 cases, the PICA and the anterior inferior cerebellar artery (AICA) in two, the PICA and vertebral artery (VA), and AICA and VA in one case each. The patient with atypical pain had compression by a large vein. In 15 cases of arterial compression, the pain completely disappeared after MVD, and there was no recurrence during the follow-up period, which ranged from 1 month to 4 years. One patient with venous compression had significant pain relief, although mild throat pain persists. In one case, postoperative complications included transient 6th, 7th, and 10th nerve palsies and sensory disturbance, which were assumed to be due to disturbance of the circulation in the perforating branches from the compressing artery. The experience with these 16 patients indicates that vascular compression is the etiology of glossopharyngeal neuralgia and that MVD provides excellent results.