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Glossopharyngeal neuralgia (GPN) is an uncommon facial pain syndrome and is characterized by paroxysms of excruciating pain in the distributions of the auricular and pharyngeal branches of cranial nerves IX and X. Glossopharyngeal neuralgia characterized by otalgia alone is rare. Herein, the authors analyzed 2 patients with GPN with otalgia as the main clinical manifestation. The clinical features and prognosis of this rare group of patients with GPN were discussed. They both presented with paroxysmal pain in the external auditory meatus and preoperative magnetic resonance imaging suggested the vertebral artery were closely related to the glossopharyngeal nerves. In both patients, compression of the glossopharyngeal nerve was confirmed during microvascular decompression, and the symptoms were relieved immediately after surgery. At 11 to 15 months follow-up, there was no recurrence of pain. A variety of reasons can cause otalgia. The possibility of GPN is a clinical concern in patients with otalgia as the main complaint. The authors think the involvement of the glossopharyngeal nerve fibers in the tympanic plexus via Jacobson nerve may provide an important anatomic basis for GPN with predominant otalgia. Surface anesthesia test of the pharynx and preoperative magnetic resonance imaging is helpful for diagnosis. Microvascular decompression is effective in the treatment of GPN with predominant otalgia., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

Object: Microvascular decompression (MVD) is the best curative treatment for trigeminal neuralgia and hemifacial spasm. We used the neuronavigation to reconstruct the 3D image of cranial nerve and blood vessel to identify the neurovascular compression, and to reconstruct the venous sinus and skull to optimize craniotomy., Patients and Methods: A total of 11 trigeminal neuralgia and 12 hemifacial spasm cases were selected. All patients had preoperative MRI which included 3D Time of Flight (3D-TOF), Magnetic Resonance Venography (MRV) and computer tomography (CT) for navigation. Imaging sequences were fused and reconstructed by navigation system before operation. The 3D-TOF images were used to delineate cranial nerve and vessel. The CT and MRV images were used to mark transverse sinus and the sigmoid sinus for craniotomy. All patients underwent MVD and have the preoperative view compared with intraoperative findings., Results: Approaching to the cerebellopontine angle right after opening the dura and got no cerebellar retracion or petrosal vein rupture during craniotomy. Ten of 11 trigeminal neuralgia and all 12 hemifacial spasm patients got excellent preoperative 3D reconstruction fusion images, which were also confirmed by intraoperative findings. All 11 trigeminal neuralgia patients and 10 of 12 hemifacial spasm patients were symptom free without any neurological complications just after the surgery. Other 2 hemifacial spasm patients got delayed resolution in 2 months after surgery., Conclusions: Through the neuronavigation guided craniotomy and the 3D neurovascular reconstruction, surgeons can better identify the compression of nerve and blood vessel, and reduce complications., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

Microvascular decompression (MVD) has a satisfactory safety, and it is the only surgical treatment for neurovascular compression diseases, such as hemifacial spasm, trigeminal neuralgia, and glossopharyngeal neuralgia, from the perspective of etiology. Bilateral dilated and fixed pupils have long been regarded as a sign of life threatening, which is common in patients with cerebral herniation due to cranial hypertension. However, transient dilated pupils after MVD have not been previously reported. Here, we presented 2 patients with bilateral transient dilated and fixed pupils after MVD and discussed the possible etiologies through the literature review. Physical examination of both patients showed bilateral pupils were normal and without a medical history of pupil dilation. They underwent MVD under general anesthesia and used propofol and sevoflurane. In both cases, the vertebral artery was displaced, and Teflon pads were inserted between the vertebral artery and the brain stem. Postoperation, we found transient bilateral mydriasis without light reflection in both patients. The emergency head computed tomography revealed no obvious signs of hemorrhage and cerebral herniation. About 1 hour later, this phenomenon disappeared. Therefore, the authors think if MVD is successfully carried out, bilateral transient mydriasis may not necessarily indicate brain stem hemorrhage, cerebral herniation, and other emergency conditions, which can be recovered within a short time. The causes could be related to stimulation of the sympathetic pathway in the brain stem during MVD and side effects of anesthetics., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

Objective: The study aimed to evaluate the surgical outcomes of percutaneous balloon compression (PBC) and microvascular decompression (MVD) in the treatment of elderly patients with trigeminal neuralgia (TN)., Methods: A total of 30 patients who underwent PBC surgery (PBC group) and 30 patients who received MVD surgery (MVD group) were included. The treatment efficacy, Barrow Neurological Institute (BNI) pain intensity score, inflammatory response, the rates of complication and recurrence were analyzed respectively., Results: The total efficacy was 93.33% in the PBC group and 90.00% in the MVD group (P > 0.05), respectively. The pain relief rate was 90.00% and 86.67% after PBC and MVD surgery, respectively (P > 0.05). The levels of IL-1β, TNF-α, and IL-6 were significantly decreased at post-operative 3 days and 5 days compared with pre-operation in the 2 groups (P < 0.05). The post-operative complication rates regarding masticatory muscle weakness and facial numbness in the PBC group were higher than MVD group (P < 0.05). Nevertheless, the incidences of herpes simplex and keratohelcosis were similar between the 2 groups (P > 0.05). The recurrence rates were also similar between the 3 groups (P > 0.05)., Conclusion: Percutaneous balloon compression and MVD are effective in the treatment for elderly TN, which can effectively improve the post-operative cure rate of pain prognosis and reduce the inflammatory response. However, PBC is a minimally invasive, safe and effective method for patients in poor general condition and refused treatment with craniotomy.

Objectives: The aim of the present study is to investigate effect of hypertension and diabetes on neuroelectrophysiology, outcomes and complications in patients with hemifacial spasm (HFS) treated by microvascular decompression (MVD)., Methods: From June 2014 to December 2016, 476 consecutive HFS patients who had undergone MVD were divided into 2 groups according to the presence or absence of comorbidities: diabetic group (n = 26) versus non-diabetic group (n = 450), and hypertensive group (n = 141) versus normotensive group (n = 335). Relevant patient data, including preoperative and postoperative neuroelectrophysiology, operative findings, outcome of MVD and complications, were collected and analyzed retrospectively over the 2-year follow-up period. The impact of hypertension and diabetes on the clinical features of HFS patients was investigated by using logistic regression models., Results: Brainstem auditory evoked potential (BAEP), postoperative prognosis and abnormal muscle response (AMR) were not different between any of the 2 groups. Preoperative positive AMR occurred more frequently in the nondiabetic group than diabetic group [OR = 0.202, P = 0.004], whereas hypertension was not independently predictive for neuroelectrophysiology in patients with HFS. Adjusted multivariate analysis indicated that hypertension was the only clinical factor associated with MVD-related complications [OR = 0.482, P = 0.007] and hearing impairment [OR = 0.28, P = 0.004] after various potential confounders were taken into account, whereas diabetes was not predictive for postoperative complications., Conclusions: Diabetes is associated with low positive rate of preoperative AMR, thus weakening the predictive role of AMR for successful MVD. Hypertension may be an independent risk factor for hearing impairment after MVD.

Object: Microvascular decompression (MVD) is the most popular surgical procedure for treating Trigeminal neuralgia (TN). In this article, the authors conducted a large case series in which patients underwent MVD for TN, and focus on surgical outcomes, intraoperative findings, complications and risk factors., Methods: From January 2017 to June 2017, a total of 84 patients with TN were treated with MVD in our department. The authors retrospectively analyzed the surgical outcomes and postoperative complications of these patients. Risk factors were analyzed by binary logistic regression analysis., Results: Of the 84 patients, 69 had complete postoperative symptom relief (BNI I-II). A total of 28 patients developed postoperative facial numbness (BNI III-IV) and 1 patient died intraoperatively. With binary logistic regression analysis, significant risk factors for postoperative Facial numbness (FN) were longer operation time (odds ratio [OR] 1.153, P <0.05) and longer hospital stay (OR 1.371, P <0.05). The patients' age, the length of the disease, the gender, and the side of the disease did not affect the occurrence of postoperative FN., Conclusions: The study found that patients with TN treated with MVD had a good response rate after surgery. The incidence of FN after surgery is not low, and longer duration of surgery and longer hospital stay are risk factors for FN. In the case of ensuring the success rate of surgery, reducing unnecessary operations, reducing the operation time, will help to reduce the occurrence of FN.

Objective: The aim of the study was to evaluate the efficacy of microvascular decompression (MVD) and stereotactic gamma knife surgery (GKS) in the treatment of trigeminal neuralgia (TN) in the elderly., Patients and Methods: Retrospective analysis of 137 elderly cases with TN underwent MVD, partial sensory rhizotomy (PR) treatment from August 2007 to March 2017 and 56 cases underwent GKS treatment from May 2014 to February 2017 was made, compared the efficacy of MVD and GKS in different age groups., Results: In 125 patients of MVD alone, the responsible vessels included 60 cases of superior cerebellar artery, 55 cases of anterior inferior cerebellar artery, 4 cases of venous vascular compression, 13 cases of mixed arteriovenous compression and 3 cases of vertebral artery, and 2 cases of no responsible vessel. Operation methods: MVD 125 cases, MVD + PR 10 cases, PR 1 cases, simple exploration in 1 case. Results of MVD surgery: Among 125 patients of MVD alone, 95 cases were cured, 15 cases improved, and 15 cases were ineffective. Among 10 cases of MVD + PR, cured in 9 cases and improved in 1 case. PR and simple exploration in 2 cases got pain disappeared. Postoperative complications of MVD: No deaths, CSF leakage in 2 cases, intracranial infection in 3 cases, ipsilateral hearing loss in 1 case, and ipsilateral facial paralysis in 1 case, delayed intracranial hematoma in 2 cases. After GKS treatment, the shortest onset time was from 9 days up to 6 months, an average of 2.2 months. Among 56 patients, 30 cases were cured, accounting for 53.6%, 20 cases improved, accounting for 35.7%, 6 cases were ineffective, accounting for 10.7%. Postoperative complications were facial numbness and dysesthesia, 7 cases, the incidence was 12.5%. In the group of 60 to 70 years old and the group of 70 to 80 years old, the treatment effect of MVD was better than that of GKS (χ test, P < 0.05); there was no significant difference between MVD and GKS in >80 years old group (χ test, P > 0.05). There was no significant difference in the therapeutic effect of TN underwent GKS among all age groups (χ test, P > 0.05)., Conclusion: Microvascular decompression should be performed more prudently in elderly patients (>80 years old), and the indications for PR should be relatively relaxed. MVD + PR could improve the curative effect in patients with trigeminal neuralgia >80 years. Gamma knife treatment of trigeminal neuralgia had high safety, less complications, and positive curative effect, especially suitable for patients >80 years.

Objective: This study explored the technical characteristics and effectiveness of sling retraction technique in microvascular decompression for hemifacial spasm., Methods: Between January 2008 and May 2016, 158 patients affected by hemifacial spasm underwent microvascular decompression. Among them, the traditional technique was performed in 86 patients (A Group) and the sling retraction technique was used in 72 patients (B Group). The authors conducted a retrospective study and compared the surgical outcome of the 2 groups. The authors measured cure rate at 3 months and 5 years after microvascular decompression., Results: In the traditional technique group, the cure rate of microvascular decompression was 94.2% and 83.3%. While in the sling retraction technique group, the cure rate of microvascular decompression was 95.8% and 94.4%. Facial nerve palsy, hearing loss, meningitis, and ataxia were frequent complications in both 2 groups., Conclusions: The sling technique using biomedical glue is an effective and safe option for patients of hemifacial spasm. During the long-term follow-up, the sling retraction technique of microvascular decompression was more effective than the traditional technique, while there were no significant differences in the incidences of complications.

Objective: To evaluate and compare the long-term efficacy and safety of microvascular decompression (MVD) and glossopharyngeal nerve roots rhizotomy (GNR) in the treatment of glossopharyngeal neuralgia (GN)., Patients and Methods: The data of 37 patients with glossopharyngeal neuralgia undergoing MVD alone and MVD + GNR from July 2004 to March 2017 were analyzed retrospectively. Among them, 22 were MVD alone and 15 were MVD + GNR. All patients underwent preoperative cocaine experiments to verify diagnoses, preoperative magnetic resonance imaging examinations to detect compressing vessels near the root entry zone of the glossopharyngeal nerve. Operation via retrosigmoid approach, keyhole craniotomy, and postoperative efficacy was followed up., Results: Efficacy: In the 22 patients with MVD alone, 19 patients were cured and 3 patients improved. In the 15 patients with MVD + GNR, 14 patients were cured and 1 patient improved. There was no significant difference between the 2 groups (χ test, P > 0.05)., Complications: Postoperative complications in MVD group: 2 patients had short-term hoarseness and drinking cough, 1 patient with cerebrospinal fluid leakage, 1 patient with intracranial infection, 1 patient with ipsilateral hearing loss, and no deaths; postoperative complications in MVD + GNR group: permanent hoarseness in 2 patients, short-term drinking cough and hoarseness in 4 patients, ipsilateral facial paralysis in 1 patient, 1 patient with cerebrospinal fluid leakage, no intracranial infection and death. The incidence of postoperative hoarseness and drinking cough in MVD + GNR group was higher than that in MVD group (χ test, P < 0.05)., Conclusion: The MVD alone was a safe and effective method for the treatment of primary glossopharyngeal neuralgia, the efficacy was equivalent to MVD + GNR, and had low incidence of hoarseness and drinking cough.

Microvascular decompression (MVD) has been confirmed as an effective treatment of trigeminal neuralgia (TN); however, most previous reports just focused on MVD for TN caused by arterial conflict, there is a paucity of information about its use in venous compression causing TN. In the present study, the authors summarize 5-year experience of MVD for primary TN due to venous compression alone. Thirty-four patients with primary TN caused solely by veins underwent MVD. The presenting symptoms, key operative notes, surgical outcomes together with complications were reviewed. Of all the 34 patients, 19 (55.9%) patients occurred as typical TN. The V2 division was the most commonly affected area. Most of the venous conflicts were grade III (20/34, 58.8%). Deep superior petrosal venous system was the most frequent offending vessel (21/34, 61.8%). The venous conflicts were located at the trigeminal root entry zone in 10 (29.4%) patients, the mid cisternal zone in 18 (52.9%) patients, and the porus of Meckel's cave in 11 (32.4%) patients. At the last follow-up, excellent outcome was obtained in 26 (76.5%) patients, 7 (20.6%) patients got good outcome, fair outcome was achieved in 7 (20.6%) patients, and 1 patient unimproved (2.9%). Cerebrospinal fluid leakage was the most common complication (5.9%). In conclusion, MVD is a safe and effective surgical option for TN due to venous compression alone. It is noteworthy to explore the entire nerve and to protect veins as much as possible.

Background: Microvascular decompression (MVD) is the most useful treatment for hemifacial spasm (HFS). In patients of vertebral artery (VA) compression of the facial nerve, MVD is often difficult. Many of the VA are obviously atherosclerotic. In this study, the authors retrospectively compared the effect of MVD for HFS associated with the atherosclerosis of vertebral artery (aVA) with that of MVD for HFS with normal vertebral artery (nVA)., Methods: A retrospective study of HFS treated by MVD was conducted between January 2014 and October 2015. There were 186 patients with VA-associated HFS who underwent their first MVD at the authors' institution. Among them, 52 patients of HFS were associated with aVA and 134 patients were associated with nVA., Results: At 1 day, 7 days, 1 month, 3 months, and 1 year after MVD surgery, in aVA group, the effective rate of MVD was 80.77%, 80.77%, 82.00%, 79.59%, and 82.61%, the incidence rate of complication was 15.83%, 13.46%, 14.00%, 12.24%, and 10.87%; in nVA group, the effective rate of operation was 94.03%, 94.78%, 95.42%, 94.53%, and 95.12% (P < 0.05), the incidence rate of complication was 4.48%, 4.48%, 3.82%, 3.13%, and 1.63% (P < 0.05)., Conclusion: When the HFS was associated with the aVA, the effective rate of MVD was lower and the incidence of complication was higher than those associated with nVA. In MVD of HFS associated with aVA, the full decompression of the facial nerve and the minimal traction of surrounding tissue in the operation are the key to the success of MVD.

The purpose of this article is to study the etiology, treatment, and prognosis of delayed facial palsy (DFP) after microvascular decompression (MVD) for the hemifacial spasm. Between January 2012 and January 2014, 562 patients who underwent MVD for hemifacial spasm at our institution were retrospectively studied. Among 562 patients, 34 patients developed DFP after MVD with an incidence of 6%. The duration of palsy was 15 to 136 days (average 51.2 days). There was statistical relevance between preoperative duration of the course, the facial nerve for indentation, and the incidence of delayed facial paralysis. All the symptoms of facial paralysis were obviously improved. DFP is not an unusual complication after MVD, and prognosis is fairly good.

Microvascular decompression has been now accepted worldwide as a reasonable treatment for trigeminal neuralgia, yet, as a functional operation in the cerebellopontine angle, this process may be risky and the postoperative outcomes might not be good enough sometimes. To assess the effectiveness and safety of microvascular decompression for treatment of trigeminal neuralgia, we conducted a systematic review. Using the keywords "trigeminal neuralgia", "microvascular decompression", or "neurovascular conflict", manuscripts published in English-language journals and indexed in PubMed between January 1, 2000 and June 1, 2013 on the treatment of trigeminal neuralgia (TN) with microvascular decompression were considered for this study. The success and complications were analyzed. The success in this investigation was defined as complete pain free. Continuous outcomes were summarized using means or medians, and dichotomous outcomes were presented as percentage associated with 95% confidence interval. Twenty-six papers with 6,847 patients were finally enrolled in this review. Among them, the male-to-female ratio was 1:1.4, the left-to-right ratio was 1:1.6, and the pain was located in the innervation of V3 and/or V2 in most of the cases with only 2.3% (0.1-4.7) of V1 exclusively. The average age at surgery was 60.9 years (52.5-64.1) with TN symptoms duration of 24.7 months (6.1-42.1) before microvascular decompression (MVD). Operative findings confirmed the superior cerebellar artery, anterior inferior cerebellar artery, posterior inferior cerebellar artery, and multiple vascular contacts (including veins) as the most common sources of nerve compression. The average follow-up duration was 35.8 months (26.2-56.6). The success rate was 83.5% (79.6-89.1). Complications included incisional infection in 1.3% (0.1-2.5), facial palsy 2.9% (0.5-6.2), facial numbness 9.1% (1.3-19.6), cerebrospinal fluid leak 1.6% (0.7-2.5), and hearing deficit 1.9% (0.2-3.9). The postoperative mortality was 0.1% (0.02-0.2). Accordingly, MVD is the most effective treatment for patients with trigeminal neuralgia. An immediate pain free can be achieved by an experienced neurosurgeon with good knowledge of the regional anatomy. To avoid complications, each single step of the process cannot be overemphasized.