Articles: microvascular-decompression-surgery.
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In microvascular decompression (MVD) surgery for hemifacial spasm (HFS), preservation of the lesser occipital nerve (LON) will prevent occipital sensory disturbance, a frequent complication of MVD, but the long-term outcome is unknown. This study was designed to evaluate the long-term efficacy of LON preservation. ⋯ Our long follow-up study has demonstrated that preservation of the LON during MVD prevents sensory disturbance of the occipital scalp. Efforts to preserve the LON appear to be worthwhile when the suboccipital approach is chosen.
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Microvascular decompression (MVD) has been the most effective long-term surgical treatment of trigeminal neuralgia (TN). However, the risk factors for poor pain control after MVD are not fully understood. ⋯ Younger patients with TN had worse long-term pain outcomes after MVD. The additional factors associated with postoperative recurrence included poor preoperative pain control (Barrow Neurological Institute score >IV) and multivessel compression. Furthermore, combined compression of the superior cerebellar artery and petrosal vein was associated with worse outcomes.
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Case Reports
Microvascular Decompression and Transposition of the 8th Cranial Nerve Using a Fenestrated Clip.
Neurovascular compression is a potential, yet rare cause of vertigo and unilateral tinnitus. Despite the high success rate of microvascular decompression (MVD) in other vascular compression syndromes, the outcome reported after MVD of the vestibulocochlear nerve is variable.1,2 The presence of combined symptoms of tinnitus and vertigo treated by MVD has demonstrated a higher predictive value for success.3 In this video, we present the case of a 68-year-old male who presented with vertigo and tinnitus refractory to medical management and vestibular therapy. Audiologic evaluation was normal apart from mild sensorineural hearing loss. ⋯ Indocyanine green angiography with Glow-800 was conducted before and after AICA transposition to confirm adequate flow through the mobilized vessel. Postoperatively, the patient's vestibular symptoms improved significantly. This case demonstrates that microvascular decompression can provide a satisfactory outcome in patients with unilateral tinnitus and vertigo associated with vascular compression in appropriately selected cases (Video 1).