Neurovascular Cross-Compression Syndromes: Surgical Approach

Ablative decompression procedures in neurosurgery have traditionally been utilized to treat neurological dysfunction syndromes. If medical therapy fails to provide relief of symptoms or if side effects occur, a decompressive procedure of neural structures should be considered. Although early explanations regarding the pathogenetic relevance of vascular and other compressive disorders of cranial nerves were provided, the therapeutic concept of surgical decompression did not gain wide acceptance initially [14, 19]. The first therapeutic approach to compression syndromes was introduced by Dandy, who noted vascular and other abnormalities in patients with trigeminal neuralgia. Dandy showed that removal of the compressing vessel from the affected nerve would produce symptom relief [12, 16, 18]. The concept of cranial nerve dysfunction syndromes was reintroduced and popularized by Jannetta in 1967 [26]. This therapeutic concept is based on vascular decompression of neural structures of the brain stem within the posterior fossa to relieve a number of hyperactive symptom complexes, including neurogenic hypertension. For surgical treatment to be successful, it is imperative that the compressing vessel be mobilized off the affected nerve by a nondestructive microvascular decompression [56].