Abstract
Abstract The aim of this work was to detect the anatomical relationship criteria of the offending vessel with respect to the cranial nerve in neurovascular compression syndrome using the endoscopic-assisted minimally invasive retrosigmoid approach for microvascular decompression (MVD); these criteria help the surgeon to define the actual conflicting vessel during surgery for better results. Between 1994 and 2009, we have performed 782 cases of MVD surgeries using endoscopic-assisted minimally invasive retrosigmoid approach (453 MVD surgeries for hemifacial spasm, 269 for trigeminal neuralgia, 56 for tinnitus and vertigo, and four decompressions for glossopharyngeal neuralgia). During these surgeries we recorded the anatomical relationships between the offending vessel and the affected cranial nerve to detect the endoscopic criteria of the offending vessel. There are certain criteria for the anatomical relationship between the offending vessel and affected cranial nerve; these criteria include common features such as a perpendicular contact between the vascular loop and the cranial nerve along two different perpendicular planes at its root exit zone, distortion of the nerve course, and distortion or compression of adjacent neural structures mainly brain stem. Other criteria include the vascular loop causing impression of the nerve or encircling the nerve causing reduction of its diameter. Certain criteria for the anatomical relationship between the offending vessel and the affected cranial nerve should be fulfilled to diagnose the actual conflicting vessel during MVD surgery in vascular compression syndrome using endoscopic-assisted minimally invasive retrosigmoid approach.
Highlights
Neurovascular compression syndrome (NVCS) is a disease caused by presence of contact between a vascular loop in the cerebellopontine angle (CPA) and one of the cranial nerves
The CPA is characterized by presence of many vascular and neural structures, which are normally in contact with each other without causing a problem; sometimes this contact causes a problem to the patient and becomes symptomatic leading to the so-called NVCS, the symptom of which depends on the compressed cranial nerve and the compressing vessel is called an offending vessel [1]
The measured criteria are the anatomical relationship between the offending vessel and the affected cranial nerve, as normally the CPA is a closed space characterized by presence of many vascular and neural structures that are normally in contact with each other; when the vascular structure comes in contact with the cranial nerve in a special anatomical manner, it may become hazardous and produce symptoms
Summary
Neurovascular compression syndrome (NVCS) is a disease caused by presence of contact between a vascular loop in the cerebellopontine angle (CPA) and one of the cranial nerves. Vascular compression syndrome of the cranial nerves, first suggested in 1934 by Dandy [2] and popularized by Jannetta in the 1970s [3], are gaining acceptance with the improvement in MRI assessment and the success of endoscope-assisted microvascular decompression (MVD) procedures; they are commonly described in trigeminal neuralgia and hemifacial spasm, but other disorders such as glossopharyngeal neuralgia and disabling positional vertigo (DPV) can be treated successfully by MVD of the respective cranial nerves It has been shown, in small series, that some cases of disabling tinnitus can be alleviated by MVD [4]. Auditory nerve with cross conflicts with tinnitus or DPV requires alternative endoscopic control from above and below the acousticofacial nerve bundle, and (level IV) an inferior extension of the CPA in which the lower medulla is readily apparent [5]
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