Abstract
Microvascular decompression surgery is an operation in which knowledge of normal anatomy is especially important because there are often no mass lesions in the cerebellopontine angle (CPA). There are three neurovascular complexes in the CPA, as described in the “rule of 3” (Hitotsumatsu et al. Neurosurgery 53:1436–1441, 2003). The three neurovascular complexes are associated with the three major neurovascular compression syndromes: the upper neurovascular complex including cranial nerve (CN) V and the superior cerebellar artery (SCA) is related to trigeminal neuralgia, the middle neurovascular complex including CNs VII and VIII and the anterior inferior cerebellar artery (AICA) is related to hemifacial spasm, and the lower neurovascular complex including CNs IX–XII and the posterior inferior cerebellar artery (PICA) is related to glossopharyngeal neuralgia. In this chapter, the microsurgical anatomy of the posterior fossa encountered in microvascular decompression surgery is introduced with the rule of 3.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- AICA:
-
Anterior inferior cerebellar artery
- CN:
-
Cranial nerve
- CPA:
-
Cerebellopontine angle
- PICA:
-
Posterior inferior cerebellar artery
- SCA:
-
Superior cerebellar artery
References
Apfelbaum RI. Neurovascular decompression: the procedure of choice? Clin Neurosurg. 2000;46:473–98.
Barker 2nd FG, Jannetta PJ, Bissonette DJ, Shields PT, Larkins MV, Jho HD. Microvascular decompression for hemifacial spasm. J Neurosurg. 1995;82:201–10.
Barker 2nd FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334:1077–83.
Campos-Benitez M, Kaufmann AM. Neurovascular compression findings in hemifacial spasm. J Neurosurg. 2008;109:416–20.
DuBois FS, Foley JO. Experimental studies on the vagus and spinal accessory nerves in the cat. Anat Rec. 1936;64:285–307.
Emmons WF, Rhoton Jr AL. Subdivision of the trigeminal sensory root. Experimental study in the monkey. J Neurosurg. 1971;35:585–91.
Ferroli P, Fioravanti A, Schiariti M, Tringali G, Franzini A, Calbucci F, et al. Microvascular decompression for glossopharyngeal neuralgia: a long-term retrospectic review of the Milan-Bologna experience in 31 consecutive cases. Acta Neurochir (Wien). 2009;151:1245–50.
Fujimaki T, Kirino T. Combined transhorizontal-supracerebellar approach for microvascular decompression of trigeminal neuralgia. Br J Neurosurg. 2000;14:531–4.
Funaki T, Matsushima T, Masuoka J, Nakahara Y, Takase Y, Kawashima M. Adhesion of rhomboid lip to lower cranial nerves as special consideration in microvascular decompression for hemifacial spasm: report of two cases. Surg Neurol Int. 2010;1:71.
Gardner WJ. Cross talk-the paradoxical transmission of a nerve impulse. Arch Neurol. 1966;14:149–56.
Gaul C, Hastreiter P, Duncker A, Naraghi R. Diagnosis and neurosurgical treatment of glossopharyngeal neuralgia: clinical findings and 3-D visualization of neurovascular compression in 19 consecutive patients. J Headache Pain. 2011;12:527–34.
Guan HX, Zhu J, Zhong J. Correlation between idiopathic hemifacial spasm and the MRI characteristics of the vertebral artery. J Clin Neurosci. 2011;18:528–30.
Gudmundsson K, Rhoton Jr AL, Rushton JG. Detailed anatomy of the intracranial portion of the trigeminal nerve. J Neurosurg. 1971;35:592–600.
Hardy DG, Rhoton Jr AL. Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve. J Neurosurg. 1978;49:669–78.
Hardy DG, Peace DA, Rhoton Jr AL. Microsurgical anatomy of the superior cerebellar artery. Neurosurgery. 1980;6:10–28.
Hitotsumatsu T, Matsushima T, Inoue T. Microvascular decompression for treatment of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia: three surgical approach variations: technical note. Neurosurgery. 2003;53:1436–41; discussion 1442–33.
Hong W, Zheng X, Wu Z, Li X, Wang X, Li Y, et al. Clinical features and surgical treatment of trigeminal neuralgia caused solely by venous compression. Acta Neurochir (Wien). 2011;153:1037–42.
Huang CI, Chen IH, Lee LS. Microvascular decompression for hemifacial spasm: analyses of operative findings and results in 310 patients. Neurosurgery. 1992;30:53–6; discussion 56–7.
Hyun SJ, Kong DS, Park K. Microvascular decompression for treating hemifacial spasm: lessons learned from a prospective study of 1,174 operations. Neurosurg Rev. 2010;33:325–34; discussion 334.
Jannetta PJ. Neurovascular compression in cranial nerve and systemic disease. Ann Surg. 1980;192:518–25.
Kandan SR, Khan S, Jeyaretna DS, Lhatoo S, Patel NK, Coakham HB. Neuralgia of the glossopharyngeal and vagal nerves: long-term outcome following surgical treatment and literature review. Br J Neurosurg. 2010;24:441–6.
Katsuta T, Rhoton Jr AL, Matsushima T. The jugular foramen: microsurgical anatomy and operative approaches. Neurosurgery. 1997;41:149–201; discussion 201–2.
Kawashima M, Matsushima T, Inoue T, Mineta T, Masuoka J, Hirakawa N. Microvascular decompression for glossopharyngeal neuralgia through the transcondylar fossa (supracondylar transjugular tubercle) approach. Neurosurgery. 2010;66:275–80; discussion 280.
Kim JP, Park BJ, Choi SK, Rhee BA, Lim YJ. Microvascular decompression for hemifacial spasm associated with vertebrobasilar artery. J Korean Neurosurg Soc. 2008;44:131–5.
Kondo A. Follow-up results of using microvascular decompression for treatment of glossopharyngeal neuralgia. J Neurosurg. 1998;88:221–5.
Laha RK, Jannetta PJ. Glossopharyngeal neuralgia. J Neurosurg. 1977;47:316–20.
Li ST, Pan Q, Liu N, Shen F, Liu Z, Guan Y. Trigeminal neuralgia: what are the important factors for good operative outcomes with microvascular decompression. Surg Neurol. 2004;62:400–4; discussion 404–5.
Lister JR, Rhoton Jr AL, Matsushima T, Peace DA. Microsurgical anatomy of the posterior inferior cerebellar artery. Neurosurgery. 1982;10:170–99.
Lorenzoni JG, Massager N, David P, Devriendt D, Desmedt F, Brotchi J, et al. Neurovascular compression anatomy and pain outcome in patients with classic trigeminal neuralgia treated by radiosurgery. Neurosurgery. 2008;62:368–75; discussion 375–6.
Martin RG, Grant JL, Peace D, Theiss C, Rhoton Jr AL. Microsurgical relationships of the anterior inferior cerebellar artery and the facial-vestibulocochlear nerve complex. Neurosurgery. 1980;6:483–507.
Matsushima T, Rhoton Jr AL, Lenkey C. Microsurgery of the fourth ventricle: part 1. Microsurgical anatomy. Neurosurgery. 1982;11:631–67.
Matsushima T, Rhoton Jr AL, de Oliveira E, Peace D. Microsurgical anatomy of the veins of the posterior fossa. J Neurosurg. 1983;59:63–105.
Matsushima T, Fukui M, Suzuki S, Rhoton Jr AL. The microsurgical anatomy of the infratentorial lateral supracerebellar approach to the trigeminal nerve for tic douloureux. Neurosurgery. 1989;24:890–5.
Matsushima T, Inoue T, Fukui M. Arteries in contact with the cisternal portion of the facial nerve in autopsy cases: microsurgical anatomy for neurovascular decompression surgery of hemifacial spasm. Surg Neurol. 1990;34:87–93.
Matsushima T, Goto Y, Natori Y, Matsukado K, Fukui M. Surgical treatment of glossopharyngeal neuralgia as vascular compression syndrome via transcondylar fossa (supracondylar transjugular tubercle) approach. Acta Neurochir (Wien). 2000;142:1359–63.
Matsushima T, Huynh-Le P, Miyazono M. Trigeminal neuralgia caused by venous compression. Neurosurgery. 2004;55:334–7; discussion 338–9.
Matsushima K, Matsushima T, Kuga Y, Kodama Y, Inoue K, Ohnishi H, et al. Classification of the superior petrosal veins and sinus based on drainage pattern. Neurosurgery. 2014;10 Suppl 2:357–67; discussion 367.
Mikami T, Minamida Y, Akiyama Y, Wanibuchi M, Sugino T, Houkin K, et al. Microvascular decompression for hemifacial spasm associated with the vertebral artery. Neurosurg Rev. 2013;36:303–8; discussion 308–9.
Moller AR, Jannetta PJ. On the origin of synkinesis in hemifacial spasm: results of intracranial recordings. J Neurosurg. 1984;61:569–76.
Nakahara Y, Matsushima T, Hiraishi T, Takao T, Funaki T, Masuoka J, et al. Importance of awareness of the rhomboid lip in microvascular decompression surgery for hemifacial spasm. J Neurosurg. 2013;119:1038–42.
Park JS, Kong DS, Lee JA, Park K. Hemifacial spasm: neurovascular compressive patterns and surgical significance. Acta Neurochir (Wien). 2008;150:235–41; discussion 241.
Resnick DK, Jannetta PJ, Bissonnette D, Jho HD, Lanzino G. Microvascular decompression for glossopharyngeal neuralgia. Neurosurgery. 1995;36:64–8; discussion 68–9.
Rhoton Jr AL. Microsurgery of the internal acoustic meatus. Surg Neurol. 1974;2:311–8.
Rhoton Jr AL. Microsurgical anatomy of decompression operations on the trigeminal nerve. In: Rovit RL, Murali R, Jannetta PJ, editors. Trigeminal neuralgia. Baltimore: Williams and Wilkins; 1990. p. 165–200.
Rhoton Jr AL. The cerebellar arteries. Neurosurgery. 2000a;47(3 Suppl):S29–68.
Rhoton Jr AL. The cerebellopontine angle and posterior fossa cranial nerves by the retrosigmoid approach. Neurosurgery. 2000b;47:S93–129.
Rhoton Jr AL. Cerebellum and fourth ventricle. Neurosurgery. 2000c;47(3 Suppl):S7–27.
Rhoton Jr AL. Jugular foramen. Neurosurgery. 2000d;47(3 Suppl):S267–85.
Rhoton Jr AL. The posterior fossa veins. Neurosurgery. 2000e;47(3 Suppl):S69–92.
Rhoton Jr AL. The temporal bone and transtemporal approaches. Neurosurgery. 2000f;47(3 Suppl):S211–65.
Rhoton Jr AL. Cerebellopontine angle and retrosigmoid approach. Neurosurgery. 2007;61(4 Suppl):S175–92.
Rhoton Jr AL. Microsurgical anatomy of the cerebellopontine angle by the retrosigmoid approach. In: Samii M, Gerganov V, editors. Surgery of cerebellopontine lesions. Berlin: Springer; 2013. p. 9–72.
Rhoton Jr AL, Buza R. Microsurgical anatomy of the jugular foramen. J Neurosurg. 1975;42:541–50.
Rhoton Jr AL, Tedeschi H. Microsurgical anatomy of acoustic neuroma. Otolaryngol Clin North Am. 1992;25(2):257–94.
Sampson JH, Grossi PM, Asaoka K, Fukushima T. Microvascular decompression for glossopharyngeal neuralgia: long-term effectiveness and complication avoidance. Neurosurgery. 2004;54:884–9; discussion 889–90.
Sekula RF, Frederickson AM, Jannetta PJ, Bhatia S, Quigley MR, Abdel Aziz KM. Microvascular decompression in patients with isolated maxillary division trigeminal neuralgia, with particular attention to venous pathology. Neurosurg Focus. 2009;27:E10.
Sindou M, Leston JM, Decullier E, Chapuis F. Microvascular decompression for trigeminal neuralgia: the importance of a noncompressive technique--Kaplan-Meier analysis in a consecutive series of 330 patients. Neurosurgery. 2008;63:341–50; discussion 350–1.
Sunderland S. Neurovascular relations and anomalies at the base of the brain. J Neurol Neurosurg Psychiatry. 1948;11:243–57.
Tarlov I. Structure of the nerve root. II. Differentiation of sensory from motor roots; observations on identification of function in roots of mixed cranial nerves. Arch Neurol Psychiatry. 1937;37:1338–55.
Thomas KL, Vilensky JA. The anatomy of vascular compression in trigeminal neuralgia. Clin Anat. 2014;27:89–93.
Tomii M, Onoue H, Yasue M, Tokudome S, Abe T. Microscopic measurement of the facial nerve root exit zone from central glial myelin to peripheral Schwann cell myelin. J Neurosurg. 2003;99:121–4.
Yang XS, Li ST, Zhong J, Zhu J, Du Q, Zhou QM, et al. Microvascular decompression on patients with trigeminal neuralgia caused by ectatic vertebrobasilar artery complex: technique notes. Acta Neurochir (Wien). 2012;154:793–7; discussion 797.
Acknowledgments
We would like to express our gratitude to Robin Barry and Jessica Striley for the assistance in preparing and completing this manuscript.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer Science+Business Media Dordrecht
About this chapter
Cite this chapter
Matsushima, K., Jiang, X., Rhoton, A.L. (2016). Microsurgical Anatomy for Microvascular Decompression Surgery. In: Li, ST., Zhong, J., Sekula, Jr., R. (eds) Microvascular Decompression Surgery. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-7366-9_2
Download citation
DOI: https://doi.org/10.1007/978-94-017-7366-9_2
Published:
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-017-7365-2
Online ISBN: 978-94-017-7366-9
eBook Packages: MedicineMedicine (R0)