Open Microvascular Decompression

Open Microvascular Decompression

James Pan (Stanford University, USA), Lily H. Kim (Stanford School of Medicine, USA), Allen Ho (Stanford University, USA), Eric S. Sussman (Stanford School of Medicine, USA), Arjun V. Pendharkar (Stanford School of Medicine, USA) and Terry C. Burns (Mayo Clinic School of Medicine, USA)
Copyright: © 2018 |Pages: 34
DOI: 10.4018/978-1-5225-5349-6.ch004

Abstract

Microvascular decompression (MVD) is a neurosurgical procedure used to treat various neuralgias of the cranial nerves. The clinical presentation, natural history, pathophysiology, and medical management of trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and nervus intermedius neuralgia is reviewed. A thorough discussion on the retrosigmoid approach for decompression of cranial nerves is presented, along with newer techniques and controversies on adjuvant therapies and neuromonitoring. The surgical outcomes of MVD are discussed, along with alternative techniques to open MVD.
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History Of The Procedure

Walter Dandy was pivotal in the development of the MVD procedure by performing the first retrosigmoid approach to access the cerebellopontine angle, which was subsequently used by future surgeons to manipulate nerves at the cranial base (Dandy, 1932). In describing the pathophysiology of TN, Dandy was the first to realize that the trigeminal nerve was often impinged by a nearby blood vessel in patients with the disorder, thereby causing the prototypical shock-like pain of the face. This was observed during the very first treatments for TN which involved sectioning the fifth nerve near the brainstem (DANDY, 1929). Although division of the trigeminal nerve resulted in relief of symptoms, permanent sensory loss was an unavoidable side effect. It was not until the 1960s when the first MVD operations for TN (GARDNER & MIKLOS, 1959) and HFS (Gardner & Sava, 1962) was described by Gardner and later popularized by Jannetta (Jannetta, 2007).

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