Microvascular decompression

Trigeminal neuralgia has been described as a clinical entity for 2.5 millennia, however effective treatment options are relatively new. Trigeminal neuralgia is commonly idiopathic but could present as a manifestation of other diseases such as multiple sclerosis or cerebellopontine angle tumors. Cushing and Dandy laid the framework for surgical treatment for idiopathic trigeminal neuralgia earlier in the twentieth century. In the eighties, Janetta introduced the concept of vascular compression theory which is the basis of Micovascular Decompression (MVD) surgery, a surgery that he pioneered and popularized. Today, microvascular decompression of the trigeminal nerve has proven to be safe and effective. Up to 80% of patients with trigeminal neuralgia not only achieve pain relief but remain pain-free a decade after surgical intervention. Success of MVD is dependent on adequate patient selection and also on meticulous performance of the steps of the operation. MVD could also be used in other disease conditions other than trigeminal neuralgia such as hemifacial spasm and glossopharyngeal neuralgia. This chapter aims to provide an overview of the clinical decision-making, surgical technique, and outcomes pertaining to microvascular decompression.