CRANIAL NERVE HYPERFUNCTION SYNDROMES. MODERN APPROACHES TO DIAGNOSIS AND TREATMENT (REVIEW)

In this article, we reviewed neurovascular conflicts of most cranial nerves with characteristic clinical syndromes and analyzed preferred treatment strategies, including surgical methods. We conducted literature review using the Pubmed database, selecting articles on cranial nerves compression syndromes, published for 10 years (from 2010 to 2020). The analysis covered all articles with information on the etiology, pathogenesis, clinical findings, diagnosis, differential diagnosis, neuroimaging, and pathomorphological assessment, as well as treatment strategies for such pathology, including surgical methods. After identifying all the articles that met the inclusion criteria and deleting duplicate data, 58 literature sources on cranial nerves compression syndromes associated with neurovascular conflict were selected. Cranial nerves compression syndromes are a complex interdisciplinary problem, often poorly understood and undetectable by neurologists. Literature sources describe cases of neurovascular conflicts with all cranial nerves except for the olfactory one. A blood vessel (an artery, less often a vein), typically in the area where a nerve root exits the brain stem acts as a compressing agent. Clinical findings are diverse and associated with nerve hyperfunction. The most common manifestations are trigeminal neuralgia, glossopharyngeal neuralgia, and hemifacial spasm. Currently, implementation of standard cranial nerve neuroimaging protocol using high-field high-power MR scanners, MR angiography, and DVI tractography into the diagnosis allows to timely detect neurovascular conflict and determine treatment tactics. Neurosurgical intervention should be considered in case of failure or poor tolerance of conservative treatment. In most cases, the operation of choice is microvascular decompression, the essence of which is to separate the compressing vessel from the nerve and insert a sponge between the nerve and the vessel.