Glossopharyngeal neuralgia (GPN) is a rare condition that produces unilateral episodic, sometimes lancinating, often triggerable pain in the posterior pharynx, tonsillar pillar, and posterior tongue, with some degree of secondary radiation toward the ipsilateral ear. The diagnosis is strictly clinical, as no imaging findings or other testing, for that matter, has been reliably linked to the syndrome. As with many pain syndromes, accurate diagnosis appears to play a major role in the outcome from medical and surgical therapy. Because of its rarity, and the unavailability of confirmatory testing, the diagnosis is often based on expert opinion rather than consensus. These characteristics make outcome studies on this condition problematic. Pollock and Boes have reported on what is, to date, the largest series of patients with this suspected diagnosis who were treated with stereotactic radiosurgery (SRS) directed at the glossopharyngeal and vagus nerves within the jugular foramen.2 They diagnosed GPN in 5 patients and treated all using SRS. An 80 Gy dose was stereotactically directed to the isocenter with MR imaging-based target localization and 4-mm collimation using a Gamma Knife surgery (GKS) system. Follow-up was variable (range 2–19 months, average 13 months). Three of the patients improved rapidly, and 2 did not. One patient was subsequently found to have head and neck cancer, with the implication that this lesion, and not idiopathic GPN, was the basis of his pain. One other patient did not improve after GKS and subsequently underwent microvascular decompression (MVD). When this failed to produce pain relief, a second posterior fossa exploration with sectioning of the glossopharyngeal nerve and upper rootlets of the vagus nerve was performed. Again, this failed to produce satisfactory pain relief, and the patient was referred to a pain rehabilitation program. Thus, there was a 40% failure rate of GKS for this group of patients suspected of having GPN. Although this cannot be rigorously proven, I suspect that this was more a failure of diagnosis than of the therapy itself. As the authors note, many, if not most neurosurgeons performing MVD for GPN, section the entirety of the glossopharyngeal nerve, as well as the rostral rootlet (or two) of the vagus nerve. This approach has been previously shown to be superior to MVD alone in a small surgical series,1 and it is the approach that I take. Given the almost uniform neurovascular association of the posterior inferior cerebellar artery and the lower cranial nerves, it is still not entirely obvious to me that GPN is a neurovascular compression syndrome. A rhizotomy approach certainly works well in this condition, and the unilateral absence of glossopharyngeal function, combined with partial loss of vagal function, produces very little overt neurological morbidity. Given this, if this rhizotomy could effectively be performed using SRS it would be an advance in the treatment of GPN. My main concern with opening the radiosurgical door to GPN is the potential for overenthusiasm by neurosurgeons and other radiation therapy specialists—who are not necessarily specialists in the diagnosis of GPN or other craniofacial pain syndromes—to treat patients with unspecified throat pain using SRS. I have observed these concerns reinforced in consultation with patients manifesting a variety of neuropathic facial pains (for example, posttraumatic or postherpetic neuralgias) who had been previously, and inappropriately, treated using SRS under the rubric of “trigeminal neuralgia.” Based on the work of Pollock and Boes, I would encourage continued careful study of the radiosurgical treatment of a highly selected group of patients who have, to the best of our diagnostic ability, a bona fide diagnosis of GPN. Their approach appears to be a promising direction, and one that might spare some patients the pain and potential morbidity of a posterior fossa craniotomy.