Microvascular Decompression for Trigeminal Neuralgia and Other Neurovascular Compression Syndromes

Abstract

Neurovascular compression syndromes (NVCS) result from the chronic pulsatile effect of posterior fossa arteries and veins on the neighboring neural structures. Trigeminal neuralgia (TGN) being the most common, other cranial nerve compression syndromes include hemifacial spasm, geniculate neuralgia (or nervus intermedius neuralgia), vestibular paroxysmia, and vagoglossopharyngeal neuralgia. Ventrolateral medullary arterial compression may be the cause for neurogenic essential hypertension and vascular compression of CN IX and X producing vocal cord dysfunction (uncontrollable cough). While conservative therapies are often attempted, microvascular decompression provides the most effective relief. In this chapter, we review the relevant anatomy and pathophysiology of trigeminal neuralgia and briefly summarize other NVCS. The relevant anatomy of most common compressing vasculature is described, including the petrosal venous complex and its tributaries. Additionally, we describe our technique and experience in microvascular decompression surgery for TGN and lower cranial nerve compression and the advantageous application of the operative neuro-endoscope and intraoperative neuromonitoring.