Authors
Morgan Broggi, Leonardo Maresca, Luca Mattioli, Marco Schiariti, Francesco Restelli, Jacopo Falco, Francesco Acerbi, Paolo Ferroli, Giovanni Broggi
Published in
Advances and technical standards in neurosurgery. Volume 56. Pages 309-333.
Abstract
Cranial nerve (CN) functional diseases, comprising trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GN), are frequently caused by neurovascular conflicts (NVCs) in the posterior fossa. This chapter examines surgical and non-surgical procedures for these conditions, emphasizing minimally invasive retrosigmoid approach (RA) for microvascular decompression (MVD) as the gold standard for definitive treatment for all of them. MVD achieves long-term pain relief in more than 80% of classical TN cases, though efficacy decreases significantly in multiple sclerosis (MS)-related TN. Technical nuances of MVD, such as patient positioning, craniectomy location, and conflict visualization via microscopic, endoscopic, or exoscopic systems, are detailed, alongside strategies to minimize complications (CSF leakage, vascular or nerve injuries). Percutaneous techniques (radiofrequency thermorhizotomy, balloon compression) and stereotactic radiosurgery offer viable alternatives, albeit with variable durability on symptoms control. Special considerations for MS-related TN, tumor-associated cases, and recurrent disease underscore the need for tailored algorithms integrating intraoperative imaging and tools. Advances in endoscopic and exoscopic visualization systems enhance intraoperative precision and ergonomics, though mastery remains technically demanding. A multidisciplinary framework is critical for optimizing outcomes.
PMID:
42393453
Bibliographic data and abstract were imported from PubMed on 03 Jul 2026.
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