Microvascular compression: an alternative view and hypothesis

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✓ The concept of microvascular compression (MVC) is discussed critically. The root entry or exit zone is defined: it is much shorter than generally realized. The anatomy of the intracranial vessels is considered, as well as known facts concerning trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia relating to MVC. The results of microvascular decompression (MVD) are analyzed; one-third of patients do not obtain an optimum result.

The evidence used to support the hypothesis of MVC, including neurophysiology, is discussed and it is believed to be insufficient and unconvincing. The basis of MVD could be trauma of the nerve during operative dissection and “decompression.” The concept of MVC might be more convincing if MVD can be shown to cure a condition such as spasmodic torticollis, which cannot be remedied by damage to or section of the same cranial nerve or nerves.

Article Information

Address reprint requests to: C. B. T. Adams, M.Chir., F.R.C.S., Department of Neurological Surgery, Radcliffe Infirmary, Oxford OX2 6HE, England.

© AANS, except where prohibited by US copyright law.

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    Photomicrograph of a section through the trigeminal sensory root showing the root entry zone, defined as the junction of central and peripheral myelin. A scale 2 mm in length is superimposed to show that the entry zone is no more than 3 mm in length. Note the 0.8-mm vessels adjacent to the root entry zone. The patient did not have trigeminal neuralgia in life. Luxol blue/cresyl violet, × 1638.

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