Microvascular decompression of cranial nerves: lessons learned after 4400 operations

Object. Microvascular decompression has become an accepted surgical techniq ue for the treatment of trigeminal neuralgia, hemifacial spasm, glossophary ngeal neuralgia, and other cranial nerve rhizopathies. The senior author (P .J.J.) began performing this procedure in 1969 and has performed more than 4400 operations. The purpose of this article is to review some of the nuanc es of the technical aspects of this procedure. Methods.. A review of 4415 operations shows that numerous modifications to the technique of microvascular decompression have occurred during the last 29 years. Of the 2420 operations performed for trigeminal neuralgia, hemifa cial spasm, and glossopharyngeal neuralgia before 1990, cerebellar injury o ccurred in 21 cases (0.87%), hearing loss in 48 (1.98%), and cerebrospinal fluid (CSF) leakage in 59 cases (2.44%). Of the 1995 operations performed s ince 1990, cerebellar injuries declined to nine cases (0.45%), hearing loss to 16 (0.8%), and CSF leakage to 37 (1.85% p < 0.01, test for equality of distributions). The authors describe slight variations made to maximize sur gical exposure and minimize potential complications in each of the six prin cipal steps of this operation. These modifications have led to decreasing c omplication rates in recent years. Conclusions. Using the techniques described in this report, microvascular d ecompression is an extremely safe and effective treatment for many cranial nerve rhizopathies.