[Trigeminal neuralgia and hemifacial spasm. Vessel-nerve antagonism]

In the last 30 years, the concept of microvascular compression has achieved widespread acceptance. Still, some remain unconvinced. A review of our 182 operations, 104 trigeminal neuralgia and 78 hemifacial spasms, shows that microvascular decompression of the trigeminal and facial nerves is effective in alleviating trigeminal neuralgia and hemifacial spasm, because it removes the actual cause of the disorder rather than simply causing local injury to the nerve. Our neurophysiological investigations, the so-called abnormal muscle response, performed intraoperatively in twenty patients with hemifacial spasm, confirm that compression of the facial nerve at the root exit zone, by a blood vessel, causes pathological and clinical responses. Microvascular decompression is an extremely safe and effective treatment, even for the older patients without severe disabilities.