Advance Access: Macrovascular Decompression of the Brainstem and Cranial Nerves: Evolution of an Anteromedial Vertebrobasilar Artery Transposition Technique

Microvascular decompression (MVD) has become an accepted and widespread treatment for trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. Walter Dandy made early observations relating to neurovascular compression syndromes in the posterior fossa,1 and Peter Jannetta developed the modern technique for MVD using Teflon pledgets to pad pulsating arteries and displace them away from affected nerves.24 Superior cerebellar arteries, anterior inferior cerebellar arteries (AICAs), and posterior inferior cerebellar arteries (PICAs) are the common culprits in trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia, respectively, although the compression could be from a combination of arteries, their branches, perforating arteries, and even veins.4 Janetta reported complete relief from trigeminal neuralgia pain with MVD in 70% of 1185 patients at 10-yr follow-up.5

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