Neurovascular decompression for cranial rhizopathies.

For some cranial rhizopathies, such as hemifacial spasm and glossopharyngeal neuralgia, treatment has been unsatisfactory. Neurovascular decompression now offers a cure in almost 90% of these cases. In spite of the availability of alternative minor surgical procedures for trigeminal neuralgia, neurovascular decompression, being non-destructive, is a superior method of treatment. Vascular compression may also play a role in atypical facial pain and decompression may offer relief in this intractable condition. Vascular compression was not observed on exploration for nervus intermedius neuralgia, spasmodic torticollis and Meniere's disease. However, microsurgical techniques for selective section of nerves have been beneficial in Meniere's disease and nervus intermedius neuralgia. Neurovascular decompression is a relatively major procedure and is associated with a complication rate of 15%, deafness being most significant. Surgical expertise, a familiar operating team and possibly intraoperative monitoring facilities can reduce these complications.