COMBINED HYPERACTIVE DYSFUNCTION SYNDROME OF THE CRANIAL NERVES - TRIGEMINAL NEURALGIA, HEMIFACIAL SPASM, AND GLOSSOPHARYNGEAL NEURALGIA - 11-YEAR EXPERIENCE AND REVIEW

OBJECTIVE: A pathological condition caused by vascular compression at the root entry/exit zone of the cranial nerves is designated hyperacti ve dysfunction syndrome (HDS) of the cranial nerves. Patients with HDS who exhibited a combination of trigeminal neuralgia (TN), hemifacial spasm (HFS), and/or glossopharyngeal neuralgia were retrospectively re viewed, to study the incidence, etiological factors, and demographic c haracteristics for this combined HDS group. METHODS: Medical and surgi cal records were analyzed for 41 patients with combined HDS, of 1472 c onsecutive patients with HDS who were treated between 1984 and 1994. R ESULTS: The combined HDS group accounted for 2.8% of all patients with HDS; 19 patients (1.3%) exhibited bilateral symptoms, i.e., 14 cases of TN, 3 of combined TN and HFS, and 2 of HFS. Twenty-two patients (1. 5%) exhibited ipsilateral symptoms, i.e., 19 cases of TN and HFS and 3 of TN and glossopharyngeal neuralgia. Excluding three patients whose symptoms were associated with brain tumors or arteriovenous malformati ons, this patient group was older (63.2 versus 55.3 yr, P = 0.0009) an d exhibited an increased percentage of associated hypertension (47.4 v ersus 17.5%, P = 0.000008), with a female predominance (86.8 versus 71 .3%, P = 0.07), compared with the single HDS group. Thirty-six of thes e patients underwent a total of 61 microvascular decompression procedu res, with favorable outcomes. The offending vessels were similar to th ose in single HDS, which were usually conventional and multiple. CONCL USION: The associated etiological factors for vascular compression syn dromes were more evident in the combined HDS group than in the single HDS group. Progressive arteriosclerotic vasculoarchitectural changes o f the vertebrobasilar system, accelerated by aging and hypertension, b ring about the development of combined HDS, with a remarkable female p redominance.