Long-term results of microvascular decompression for trigeminal neuralgia and hemifacial spasms according to preoperative symptomatology

Background

Microvascular decompression (MVD) is currently used in several centres for the treatment of trigeminal neuralgia (TN) and hemifacial spasms (HFS). How long-term results relate to the preoperative symptoms still needs to be documented. The primary aim of this study was to assess long-term results of MVD for TN and HFS, as related to the types of preoperative symptoms.

Methods

We performed a retrospective study including all first-time MVDs for TN and HFS done during the 11-year period (1999–2009) in the Department of Neurosurgery, The National Hospital (Rikshospitalet), Oslo. The patients were categorized depending on the pre-operative symptomatology.

Results

The study population includes 303 first-time procedures performed by the senior author (PKE), 243 TN patients (65 % TN without constant pain and 35 % TN with constant pain) and 60 HFS patients (95 % typical HFS and 5 % atypical HFS). The patients were followed for a mean 71 months (range, 14–147). In both the TN and HFS patients, MVD caused lasting symptom relief in a high proportion of patients, including patients with atypical symptoms.

Conclusion

After MVD for TN and HFS, regardless of preoperative symptoms, lasting relief is observed in a high proportion of patients, with a favorable complication profile.     

Microvascular decompression for neurovascular conflicts in the cerebello-pontine angle: which role for endoscopy?

Background

Microvascular decompression (MVD) is the surgical intervention designed to resolve neurovascular conflicts (NCs) in the cerebellopontine angle (CPA). Today, endoscopy is commonly used in many neurosurgical procedures. This study aims to retrospectively assess the usefulness of endoscopy during MVD, focusing on microscopic endoscopic-assisted (MEA) MVD.

Methods

Between January 2010 and December 2012, 141 patients underwent MVD procedures: 119 (84.5 %) were affected by idiopathic trigeminal neuralgia (TN), 20 (14 %) by hemifacial spasm (HFS), 1 by glossopharyngeal neuralgia (GN) and 1 by TN and GN simultaneously; 128 (91 %) MVD were first time procedures, while 13 (9 %) were recurrences (10 TN, 3 HFS). Visualization techniques used were: pure microscopic in 89 (63 %) cases, fully endoscopic in 12 (8.5 %) and MEA in 40 (28.5 %). The MEA technique was used when the conflict was not clearly identified under microscopic view or it was not certainly resolved.

Results

Overall, a NC was found in 130 (92 %) cases, while 11 patients had no intraoperative evidence of NC. Considering specifically the 40 MEA cases, 12 (8.5 % overall) conflicts not clearly visible with the microscope were revealed and solved, a complete conflict resolution was confirmed in 13 (9 % overall) cases, while an incomplete conflict resolution was shown in four cases (3 % overall).

Conclusion

Pure microscopic MVD remains the technique of choice. The endoscope is a useful adjunctive imaging tool in confirming NCs identified by the microscope, revealing conflicts missed by the microscopic survey alone and verifying adequate nerve decompression.     

Emprical factors associated with Brainstem auditory evoked potential monitoring during microvascular decompression for hemifacial spasm and its correlation to hearing loss

Background

Cranial nerve VIII is at risk during microvascular decompression (MVD) for hemifacial spasm (HFS). The primary aim of this study is to evaluate the empirical factors associated with brainstem auditory evoked potential monitoring and its correlation to post operative hearing loss (HL) after MVD for HFS.

Methods

Pre-operative and post-operative audiogram data and BAEP from ninety-four patients who underwent MVD for HFS were analyzed. Pure tone audiometry (PTA) and Speech Discrimination Score (SDS) were performed on all patients before and after surgery. Intraoperative neurophysiological data were reviewed independently. HL was assessed using the AAO-HNS classification system for non-serviceable hearing loss (Class C/D), defined as PTA >50 dB and/or SDS <50 % within the speech range of frequencies.

Results

Patients with HL had higher rates of loss in the amplitude of wave V and prolongation in the interpeak latency of peak I-V latency during MVD. Gender, age, side, and MVD duration did not increase the risk of HL. There was no correlation between successive number of BAEP changes (reflective of the number of surgical attempts) and HL. There was no association between the speed of recovery of BAEPs and HL.

Conclusions

Patients with new post-operative HL have a faster rate of change in the amplitude of wave V and the interpeak I-V latency during intraoperative BAEP monitoring for HFS. Our alarm criteria to inform the surgeon about impending nerve injury might have to be modified and prospectively tested to prevent rapid change in BAEPs.     

A recommendation on the basis of long-term follow-up resultsof our microvascular decompression operation for hemifacial spasm

Background

Microvascular decompression (MVD) for hemifacial spasm (HFS) has been popular, but it may take enough time to master this special operative technique and procedure. This may induce uneven distribution of the number of MVD operations in each institute, possibly resulting in an overall unsatisfactory quality of MVD surgeons. Nakanishi’s approach to MVD operations has the feature of using a, “supine, no retractor” technique, which would achieve various benefits for patients and medical professionals. We would like to recommend this approach for MVD surgeons on the basis of our follow-up outcomes.

Methods

A questionnaire, which was based on the method of evaluation for the long-term results of post-MVD operation as recommended by the Japanese Society of MVD, was sent by mail to the 154 HFS patients who had received Nakanishi’s approach at our hospital.

Results

Except for 42 patients who had changed their residences, 89 patients (79.5 % of 112) fully answered. The mean postoperative follow-up term was 13.0 years. The 76.4 % of the patients was estimated as excellent. Postoperative deafness was not present. The average value of satisfaction degree for the results of the MVD operation was 87.9 %.

Conclusions

This study revealed that Nakanishi’s approach produced good results equivalent of other approaches for HFS patients. This approach is considered to have many advantages comparing to the other approaches. Therefore, we would like to recommend that Nakanishi’s approach would contribute to overall advancement of the level of MVD surgeons.     

Management of symptomatic hemifacial spasm or trigeminal neuralgia

Hemifacial spasm (HFS) or trigeminal neuralgia (TN) is a kind of hyperactivity disorder of cranial nerves caused by vascular compression. However, sometimes, the disease may arise from nerve damage produced by tumors, which was called as symptomatic HFS/TN. Until now, little is known about the exact mechanism and the necessity of microvascular decompression (MVD) regarding the tumor-induced HFS/TN, which is necessary to be retrospectively analyzed in a considerable sample. Among the 4021 patients who underwent MVD in our department between 2006 and 2014, 44 were finally diagnosed as symptomatic HFS or TN. These patients were focused in this study and their clinical features as well as intraoperative findings and postoperative outcomes were retrospectively investigated. Data analysis exhibited the symptomatic HFS/TN cases accounted for 1.1 % in the study, which were caused by epidermoid in 18 (40.9 %) and meningioma in 15 (34.1 %) followed by neuroma in 7 (15.9 %) as well as aneurysm in 2 (4.5 %) and arteriovenous malformation in 2 (4.5 %). Compared to those with idiopathic HFS/TN, younger females were more susceptible (p?<?0.05). After resection of the neoplasm, the offending vessel was identified in 26 (59.1 %), which were followed by MVD process. Postoperatively, the symptoms relief rate was 88.6 %. Our study showed that surgical management of patients with symptomatic HFS/TN may lead to a satisfactory result, yet those primary lesions should be removed firstly. In some cases, a microvascular decompression process might be unnecessary afterward, but the entire nerve root should be checked to exclude any vessel in contact with.     

Re-operation for persistent hemifacial spasm after microvascular decompression with the aid of intraoperative monitoring of abnormal muscle response

Background and objectives

Microvascular decompression (MVD) is the only solution that can effectively control hemifacial spasm (HFS). Regarding treatment of the patients who failed the first operation, it is still controversial. We tried to evaluate the safety and efficiency of the early re-exploration for such kinds of patients.

Methods

Thirteen patients failed the first MVD and received a second MVD procedure. The spasm was not resolved at all or became even more severe after the first MVD. Abnormal muscle response (AMR) persisted during the first MVD operation or disappeared once but emerged again. The patient had a strong will to do the re-operation and was aware of the high risks of operative complications.

Results

All the 13 patients got good or excellent spasm resolution immediately after the re-operation, which involved whole-range exploration and intraoperative AMR monitoring; however, there were two cases (15.4%) of permanent facial weakness and three cases (23.0%) of transient facial weakness.

Conclusions

Our experience on early repeat MVD is whole-range exploration and intraoperative AMR monitoring; in other words, re-operation cannot rely too much on experience.     

Usefulness of the endoscope in microvascular decompression for trigeminal neuralgia and MRI-based prediction of the need for endoscopy

Background

Microvascular decompression (MVD) is a documented effective treatment of trigeminal neuralgia (TN). Lately, reports on endoscopy-assisted microvascular decompression (eaMVD) with better outcome and less risk have emerged. This study was undertaken to verify under which circumstances the endoscope proved essential in identifying the neurovascular conflict (NVC) during eaMVD for TN, and to assess the possibility to predict the need for the endoscope on preoperative magnetic resonance imaging (MRI).

Methods

Retrospective analysis of 97 patients with TN undergoing eaMVD at the Oslo University Hospital – Rikshospitalet, 1999–2009. To assess the NVC and anatomical variations, surgical reports were evaluated. MRI was available in 66 patients. The MRIs were evaluated by a blinded neuroradiologist.

Results

In 27 of the 97 patients (27.8 %), the endoscope was a significant aid in identifying the NVC, due to a bony ridge obscuring the view of the fifth nerve, a very distal vascular compression, or a combination of both. The preoperative MRI over-diagnosed the presence of a bony ridge. However, the MRI-based fraction of microscopically visible trigeminal nerve (FVN) in the cerebellopontine angle cistern proved diagnostic (ROC curve, AUC 0.89, p?=?<0.001) with an optimal cut-off value of 0.35. Hence, if less than 35 % of the trigeminal nerve is visible on preoperative MRI, the endoscope will be needed to identify the NVC.

Conclusions

The endoscope is a valuable tool during MVD for TN, especially under anatomical circumstances such as a bony ridge hiding the direct microscopic view of the NVC. These anatomical circumstances can be predicted with good accuracy on preoperative MRI.     

Preoperative assessment of hemifacial spasm by the coronal heavily T2-weighted MR cisternography

Background

Microvascular decompression (MVD) has become a well-established surgical procedure for hemifacial spasm (HFS). Before surgery, it is essential to evaluate any possible deformity of the brainstem and establish the precise location of the offending vessels. In the present study of HFS patients we examined coronal sections taken by heavily T2-weighted MR cisternography in addition to routine axial sections, and assessed the usefulness of these images through comparison with intraoperative findings.

Methods

Eighty patients with HFS underwent preoperative coronal heavily T2-weighted MR cisternography before microvascular decompression surgery. Three neurosurgeons examined the preoperative axial and coronal MR images and evaluated vessel invagination into the brainstem. The usefulness of coronal sections was assessed statistically by the Mann-Whitney U test.

Results

Invagination of the offending vessel into the brainstem was observed in 24 cases (30.0%). In 19 patients, it was predicted preoperatively that compression of the flocculus and brainstem would be required in order to approach the offending vessels. Coronal MR cisternography was significantly more useful in cases with vessel invagination into the brainstem than in cases without invagination.

Conclusions

Coronal sections obtained by MR cisternography are able to demonstrate the severity of vessel invagination into the brainstem as well as revealing the presence of the offending vessel. This information is helpful for planning a suitable approach to the root exit zone.     

Validation and evaluation of the volumetric measurement of cerebellopontine angle cistern as a prognostic factor of microvascular decompression for primary trigeminal neuralgia

Background

The aim of this study was to analyze the prognostic factors of trigeminal neuralgia (TN) after microvascular decompression (MVD), and to evaluate the volumetric parameters of the cerebellopontine angle (CPA) cistern as a pathogenic factor and imaging predictor.

Methods

This retrospective study included 70 patients with primary TN treated with pure MVD, followed up for at least 1 year and evaluated by high-resolution MR imaging. The volume of the CPA cistern was calculated bilaterally, and the “Cistern Deviation Index” was defined to represent degree of deviation of the CPA cistern. Clinical data and volumetric parameters were compared between patients with TN and age- and sex-matched controls without TN, and between the recurrent and non-recurrent patients.

Results

The transposition procedure had a better outcome than the interposition procedure (P?<?0.001). There was a significant difference in the volume of CPA cistern between the affected and unaffected side (152.1?±?50.1 vs. 179.9?±?63.7 mm³, P?<?0.001) in patients with TN, while no significant difference between the right and left side (158.7?±?44.6 vs. 163.1?±?49.8 mm³, P?=?0.162) in controls. The Cistern Deviation Index was significantly larger in controls than in patients with TN (P?=?0.048), and in the non-recurrent patients than in recurrent patients (P?=?0.040).

Conclusion

We demonstrated that the volumetric parameters of the CPA cistern are a marker for understanding the pathogenesis of TN and useful for predicting the recurrence after MVD. The Cistern Deviation Index might contribute to deciding the surgical approach.     

Combined intraoperative monitoring of abnormal muscle response and Z-L response for hemifacial spasm with tandem compression type

Background

Multiple neurovascular compression is present in about 38 % cases of hemifacial spasm (HFS). In these cases, the vertebral artery (VA) compresses another vessel, which in turn compresses the nerve. This type was named as “the tandem type”. In the tandem type, the real offending vessel is often concealed by the VA. It is sometimes neglected by the surgeons. In this study, we report our experience in using abnormal muscle response (AMR) and ZL-Response (ZLR) simultaneously as intraoperative monitoring for MVD surgery of HFS with “the tandem type” vascular compression involving VA.

Methods

Fourteen “tandem type” patients treated with microvascular decompression surgery (MVD) surgery were included. ZLR and AMR were recorded simultaneously to identify the offending vessels in operation.

Results

After MVD surgery, 13 patients achieved excellent resolution of spasm. In one case, the patient failed to attain resolution in the first operation, underwent early reoperation and had good resolution. There were no operative deaths or serious operative complications. In all 14 cases, we found that VA compressed the anterior inferior cerebellar artery (AICA) or posterior inferior cerebellar artery (PICA), which in turn compressed the root exit zone (REZ). A typical ZLR was identified from the AICA or PICA but not from the VA. AMR was absent in one case and persisted in one case. After the VA was transposed, the typical AMR was unchanged, unstable or disappeared, and ZLR from the AICA/PICA also existed. AMR and ZLR did not disappear until AICA/PICA was sufficiently decompressed.

Conclusions

The combination of AMR and ZLR provides more useful information than does the AMR alone, and ZLR may be the only useful intraoperative monitoring for MVD surgery in times when AMR is absent or persists. ZLR played a crucial role in finding the real offending vessel, which was often concealed by the VA in tandem type.     

Results of reoperation for failed microvascular decompression

Summary Among 64 patients with hemifacial spasm (HFS) and 60 with trigeminal neuralgia (TN) treated by microvascular decompression (MVD), repeated MVD performed on 3 cases with HFS resulted in the absence of spasm in all cases. In 7 cases with TN, this technique resulted in complete remission in 2, recurrence in 3, and no pain relief in 2 cases. MVD was more effective on HFS than on TN in repeated procedures as well as for initial treatment. The cause of recurrence of HFS was attributed to the inadequate cushion effect of muscle as a prosthesis, while that for TN was suspected to be related more to post-operative fibrotic adhesions formed around the fifth nerve.     

Microvascular decompression in patients with coexistent trigeminal neuralgia,hemifacial spasm and glossopharyngeal neuralgia

Background

Trigeminal neuralgia(TN), hemifacial spasm (HFS) and glossopharyngeal neuralgia (GPN) were referred to hyperactive dysfunction syndromes (HDSs) of the cranial nerves. These symptoms may occur synchronously or metachronously, but the combination of three diseases is extremely rare.

Methods

From 2007 through 2013, six patients with coexistent GPN-HFS-TN were treated in our department. The combined symptoms occurred on the same side in three and on both sides in three. These patients underwent nine microvascular decompression (MVD) procedures in total. The clinical data including operative findings were respectively analyzed, and the etiological factors as well as treatment strategies were discussed.

Results

Intraoperatively, in all the cases a small posterior fossa was found, which was crowded with cranial nerve roots and cerbellar vesels. Postoperatively, spasm was stopped immediately in four and within 3 months in two; the symptom of TN disappeared immediately in four and within 2 weeks in two; the symptom of GPN was relieved immediately in four and improved with medication in two. During the up to 77 months’ follow-up, no changes, recurrence or any dysfunctions of cranial nerves were observed in any of the patients.

Conclusions

The combination of HFS-TN-GPN is extremely rare and is often associated with a looped VBA and a smaller posterior fossa. However, MVD is still a good choice for treatment. To achieve a safe and effective outcome, dissection of the caudal cranial nerves and proximal transposition of the vertebral artery before decompression of the affected nerve roots are strongly recommended.     

Preoperative assessment of trigeminal neuralgia and hemifacial spasm using constructive interference in steady state-three-dimensional Fourier transformation magnetic resonance imaging

Results of microvascular decompression (MVD) for trigeminal neuralgia (TN) and hemifacial spasm (HFS) may be improved by accurate preoperative assessment of neurovascular relationships at the root entry/exit zone (REZ). Constructive interference in steady state (CISS)-three-dimensional Fourier transformation (3DFT) magnetic resonance (MR) imaging was evaluated for visualizing the neurovascular relationships at the REZ. Fourteen patients with TN and eight patients with HFS underwent MR imaging using CISS-3DFT and 3D fast inflow with steady-state precession (FISP) sequences. Axial images of the cerebellopontine angle (CPA) obtained by the two sequences were reviewed to assess the neurovascular relationships at the REZ of the trigeminal and facial nerves. Eleven patients subsequently underwent MVD. Preoperative MR imaging findings were related to surgical observations and results. CISS MR imaging provided excellent contrast between the cranial nerves, small vessels, and cerebrospinal fluid (CSF) in the CPA. CISS was significantly better than FISP for delineating anatomic detail in the CPA (trigeminal and facial nerves, petrosal vein) and abnormal neurovascular relationships responsible for TN and HFS (vascular contact and deformity at the REZ). Preoperative CISS MR imaging demonstrated precisely the neurovascular relationships at the REZ and identified the offending artery in all seven patients with TN undergoing MVD. CISS MR imaging has high resolution and excellent contrast between cranial nerves, small vessels, and CSF, so can precisely and accurately delineate normal and abnormal neurovascular relationships at the REZ in the CPA, and is a valuable preoperative examination for MVD.     

Microvascular decompression for hemifacial spasm associated with the vertebral artery

In patients with vascular compression syndromes, the preoperative recognition of the cranial nerves and compressed vessels will contribute to improved surgical results. The aim of this study was to clarify the pathophysiology of hemifacial spasm (HFS) associated with the vertebral artery (VA) and to assess the value of preoperative imaging. Fifty-three consecutive patients with HFS underwent microvascular decompression (MVD). Of these, 18 cases of HFS were associated with the VA; this case series was compared with the remaining non-VA-associated HFS. For preoperative assessment, magnetic resonance imaging (MRI) was performed. Since January 2006, fusion imaging has been performed by combining MRI and computed tomography angiography. Of the 18 cases of VA-associated HFS, 17 (94.4 %) were on the left side; this was significantly higher than in the non-VA-associated HFS cases (p?<?0.0001). The VA was attached to the root exit zone (REZ) directly in three cases. In the other 15 cases, the VA was compressing the REZ indirectly as a result of other intervening vessels. In all cases, preoperative imaging fully simulated the status of the REZ. The symptom disappeared in 17 cases (94.4 %) after MVD, and there was no significant difference in the surgical results between the VA-associated group and the non-VA-associated group (p?=?0.9925). HFS associated with VA is not a rare condition. Preoperative recognition is thus important to the improvement of surgical results. Fusion imaging is useful to determine the status of the REZ, especially in indirect VA-associated HFS.     

Stitched sling retraction technique for microvascular decompression: procedures and techniques based on an anatomical viewpoint

The success of microvascular decompression (MVD) depends on the permanent and complete transposition of the offending vessels. This paper describes the stitched sling retraction techniques for treating trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GPN), focusing on the stitching point for slinging the offending artery in the appropriate direction. Between January 2007 and March 2009, 28 patients with TN, 5 patients with HFS, and 3 patients with GPN underwent MVD with a sling retraction technique. In cases of TN, MVD was performed using the infratentorial lateral supracerebellar approach, and the offending superior cerebellar artery was superomedially transposed with a sling stitched to the tentorium cerebelli. In cases of HFS, MVD was performed using the lateral suboccipital infrafloccular approach, and the offending vertebral artery was superolaterally transposed with a sling stitched to the petrous dura. In cases of GPN, MVD was performed using the transcondylar fossa approach, in which the posterior inferior cerebellar artery was inferolaterally mobilized with a sling secured to the jugular tubercle. No patient suffered recurrence in the follow-up period. For the sling retraction technique to be performed successfully, it is important for a stitch to be placed at a suitable site to sling the offending vessel in the intended direction. An appropriate surgical approach must be used to obtain a sufficient operative field for performing the stitching procedures safely.     

Outcomes of surgical treatment for hemifacial spasm associated with the vertebral artery: severity of compression,indentation, and color change

Object  

The object of surgical treatment for hemifacial spasm (HFS) is the exclusion of pulsatile neurovascular compression of the root exit zone (REZ). However, spasm persists transiently or permanently in some cases even after complete decompression. In particular, we mainly experience these results when the vertebral artery (VA) is the offender. Hence, we verified color changes of the nerve and indentations from within the operative field in HFS patients with the VA as the offender. So, we reviewed retrospectively the records of those patients who were treated with microvascular decompression (MVD) in order to assess the relationship between operative findings and clinical results.     

Delayed recurrence of hemifacial spasm after successful microvascular decompression: follow-up results at least 5 years after surgery

Background  

Microvascular decompression (MVD) for hemifacial spasm (HFS) is regarded as the gold-standard treatment due to its efficacy and durability. However, some patients still suffer from delayed recurrence after initially successful MVD.In this study, we describe our clinical experience in a single institute following up initially successful MVD for HFS 5 or more years after surgery. We analyzed the probability of, risk/predisposing factors for, and timing of delayed recurrence.     

Use of fenestrated aneurysm clips in microvascular decompression surgery. Technical note and case series

/The standard techniques of microvascular decompression (MVD) surgery in which implant materials such as shredded Teflon felt are used may be inadequate in some complex cases. The authors evaluated the use of fenestrated aneurysm clips to maintain transposition of culprit vessels in patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS). The authors conducted a retrospective review of MVD operations in which the culprit vessel was transposed and then maintained in position with a fenestrated aneurysm clip secured in position by suturing it to the dura mater. Among a consecutive series of more than 450 MVD surgeries, the fenestrated aneurysm clip sling was used in eight of the last 100 cases: six for HFS and two for TN. The follow-up period ranged from 1 to 13 months, and complete symptom resolution was noted in seven of the eight patients. No patient exhibited evidence of any surgical complications. This approach can be safely performed in complicated MVD cases such as reoperations and transpositions of long ectatic arteries. To the best of the authors' knowledge this is the first report in which the use of fenestrated aneurysm clips in MVD surgery is described.     

Outcome of microvascular decompression for hemifacial spasm associated with the vertebral artery

We retrospectively compared the outcome of microvascular decompression (MVD) for hemifacial spasm (HFS) associated with the vertebral artery (VA) with that of MVD for HFS unrelated to the VA. Between April 2008 and April 2015, 22 patients with VA-associated HFS underwent MVD at our institution. The median follow-up period was 28 months (range, 12–90 months). Results were classified as excellent in 19 patients (86 %), good in one (5 %), fair in one (5 %), and poor in one (5 %). Immediate complications developed in five patients (23 %), and one of these complications (5 %) was permanent. The surgical outcome of MVD for VA-associated HFS was similar to that of MVD for HFS unrelated to the VA; however, the incidence of complications was significantly more frequent in patients whose VA compressed the more proximal portion of the facial nerve root exit zone from the caudal side at the pontomedullary sulcus. We conclude that preoperative evaluation of VA compression patterns is important to predict the difficulty of the planned MVD procedure.     

Disease of lower cranial nerves caused by vascular compression

Between April 1989 and September 2007, 181 patients with disease of lower cranial nerves (DLCN) underwent posterior fossa exploration. As a cause of DLCN, vascular compression (VC) was present in 89 patients with trigeminal neuralgia (TN), in 6 with hemifacial spasm (HFS), in 1 with glossopharyngeal neuralgia, in 1 with Meniere's disease, and in 5 with multiple DLCN. Depending on intraoperative findings, different surgical options were used: microvascular decompression (MVD), MVD with partial sensory rhizotomy (PSR) or total sensory rhizotomy (TSR). Statistic analysis was made using the Fisher's exact 2-side test. In patients with TN, excellent outcome was archived in 83 patients and good in 6. Postoperative outcome was better (p = 0.007) in cases with severe VC, but without significant correlation between used surgical option and outcome (p = 0.402). Frequency rate of relapses did not depend on severity of VC (p = 0.502) and used surgical option (p = 0.175). In 6 patients with HFS, excellent outcome was archived in 5 with arterial compression and poor in 1 with venous contact. In patients with Meniere's disease and glossopharyngeal neuralgia, MVD result with excellent outcome. In 5 patients with multiple DLCN, excellent outcome was archived in 3 and good in 2. MVD is method of choice in surgical treatment of DLCN caused by VC. Overall outcome is better with severity of VC.