Microvascular compression of the vestibulocochlear nerve

Vascular compression of cranial nerves has been widely accepted as a cause for trigeminal neuralgia and hemifacial spasm. In contrast, vascular compression of the vestibulocochlear nerve remains controversial.

A comprehensive literature review including 175 articles between 1960 and 2020 was performed in an attempt to summarise the published hypotheses of the pathophysiological mechanisms of vascular compression of the vestibulocochlear nerve and their management strategies.

Vascular loops in the cerebellopontine angle (CPA) and internal auditory meatus (IAM) are very common and should be regarded primarily as a normal variant. Advances in anatomical understanding with the development of models for the tonotopy of the vestibulocochlear nerve help explain the complexity of symptoms created by possible neurovascular interaction.

Widely accepted, validated and sensitive diagnostic criteria and outcome measures need to be established in order to evaluate the role of surgery in vestibulocochlear nerve vascular compression.