ArticlePDF Available

Neurovascular Compression Syndromes: An Innovative Cure for Pain-Free Future

  • Nyarkotey University College of Holistic Medicine and Technology
Pandit M. Neurovascular Compression Syndromes: An Innovative Cure for Pain-Free Future. SunText Rev Neurosci Psychol 1(3):
SunText Review of Neuroscience & Psychology Open Access
ISSN: 2766-4503 Editorial Article
Volume 1:3
Neurovascular Compression Syndromes: An
Innovative Cure for Pain-Free Future
Mayukh Pandit*
Department of Anatomy, Triveni Institute of Dental Sciences Hospital & Research Centre,
Bilaspur, Chhattisgarh 495001, India
*Corresponding author: Pandit M, Department of Anatomy, Triveni Institute of Dental Sciences
Hospital & Research Centre, Bilaspur, Chhattisgarh 495001, India; E-mail: mayukhpandit17 [at]
gmail [dot] com
Editorial Article
The word neuro comes from ancient greek, a combining form
meaning nerves and nervous system which builds the compound
word: neurology [1]. Nerve could be defined in simple terms as
whitish fibers or bundle of fibers that forms a part of the system
which transmit impulses of sensation, motion and other stimuli to
brain and spinal cord and impulses from these to muscles and
organs. Our brain is the most complex organ of our body and this
complexity of relying information between brain and different
parts of body primarily to and from regions of head and neck
including sense of vision, taste, smell and hearing which is
directed from brain by Cranial nerves. Sometimes compression in
these cranial nerves could lead to develop serious chronic
vascular compression disorder due to vascular structure.
Compression in nerves could lead to demyelination which leads
to further damage of axons. So, neurovascular compression
syndromes are vascular compression disorder where cranial
nerves are compressed due to abberant vascular structures which
directly contact the cisternal portion of nucleus. Neurovascular
compression syndromes most commonly affects the transition
zone between the central and peripheral myelin [2].
There are several forms of neurovascular compression syndromes
known out of which the most common ones are Trigeminal
neuralgia and Hemifacial spasm wheras Geniculate neuralgia,
Nervous intermedius neuralgia and Vestibular Paroxysmia are the
less common ones. All this forms of Neurovascular compression
syndromes are chracterised by functional disturbances of cranial
Trigeminal Neuralgia
Trigeminal neuralgia is among the most common Neurovascular
compression syndromes known characterized by sudden
paroxysmal attack of pain lasting from few hours to several days
and confined to distribution of one or more divisions of
trigeminal nerve. International Headache Society defines
Trigeminal neuralgia as painful unilateral affliction of face
characterized by brief electric shock limited to divisions of
trigeminal nerve [3].
This chronic disorder affects more in women than in men.
Trigeminal neuralgia usually arises from blood vessles typically
Superior Cerebellar arterty which compress the 5th cranial nerve
when it exits the brain stem. This compression causes damage to
protective covering present around the myelin sheath. This injury
to myelin sheath are known to cause suffering of pain which
becomes unbearable and patients develops psychiatric disorders
which is followed by development of suicide ideation in patients.
Hence it is also called Suicide disease because it is believed more
than 50% of people commits suicide who are suffering from this
Hemifacial Spasm
Hemifacial Spasm also known by the name as Tic Convulsif
which are characterized by irregular and involuntary contraction
of facial muscle [4].
Hemifacial spasm usually arises due to offendation of facial nerve
by Anterior Inferior cerebellar artery, due to tumor or injury. It
was first demonstrated and described by Glovers in 1899. This
begins with clonic movement of orbiculis oculi and spreads to
corrugators, frontalis, orbiculi oris, platysma and zygomaticus
Received date: 19 October 2020; Accepted date: 26
October 2020; Published date: 29 October 2020
Citation: Pandit M. Neurovascular Compression
Syndromes: An Innovative Cure for Pain-Free Future.
SunText Rev Neurosci Psychol 1(3): 116.
Copyright: © 2020 Pandit M. This is an open-access
article distributed under the terms of the Creative
Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are
, SunText Rev Neurosci Psychol (2020), 1:3
Pandit M. Neurovascular Compression Syndromes: An Innovative Cure for Pain-Free Future. SunText Rev Neurosci Psychol 1(3):
progressively with years [5]. This disorder affects more in elderly
women wheras frequency is less in men. The incidence of
Hemifacial spasm is approx 0.8per 100,000 persons [6]. This
form of neurovascular compression syndromes are usually
observed more in the subcontinent of Asian countires.
Glossopharyngeal Neuralgia
Glossopharyngeal neuralgia also known by the name as Eagle’s
syndromes characterized by brief stabbing electric shock like pain
felt in throat area , back of tongue, or middle ear and as well as in
tonsils. This neuralgia is among the most rare and less common
ones. Glosspharyngeal neuralgia arises due to compression of
glosspharyngeal nerve offended by blood vessels when they exit
the brain stem. This occurs due to trauma, surgical procedure,
tumors, and vascular abnormalities or sometimes due to infections
as well. This disorder also affects more in women than men,
usually middle aged and older. The pain due to this syndrome
would be triggered while performing activities like swallowing,
speaking, laughing, chewing or coughing [7]. The duration of this
pain would lasts from few seconds to minutes and will usually
affect on one side of face.
Nervous Intermedius Neuralgia
Nervous Intermedius neuralgia also known by the name as
Geniculate neuralgia. This usually arises from vascular
compression which mainly occurs in nervous intermedius by
anterior inferior cerebellar artery. Nervous Intermedius neuralgia
was first discovered and demonstrated by John Nottingham. This
is one of the most less common syndromes which occurs with
severe and sharp unilateral peri-auricular pain and is most often
described as ‘ice-prick in the ear’ [8]. The International Headache
Society defines this neuralgia as episodes of pain usually located
deep in the ear which might last for seconds or minutes and are
often triggered by sensory or mechanical stimuli at posterior wall
of auditory canal without any pathology.
Vestibular Paroxysmia
Vestibular Paroxysmia is among the rarest of neurovascular
compression syndromes which occurs due to vascular
compression of vestibular nerve by blood vessels mainly a loop of
Anterior Inferior cerebellar artery. This disorder was first
described by Janetta in 1975 as ‘disabling positional vertigo’. The
symptoms of vestibular paroxysmia includes short attack of
spinning or non-spinning vertigo, which would usually last few
seconds to minutes and occur in a series of upto 30 or more
everyday [9]. Vestibular Paroxysmia is one the most controversial
syndromes known.
The treatment of neurovascular compression syndromes starts
with therapeutic medications at initial stage of this disorder and
once it advances requires surgical procedures for permanent cure.
Medications which are used to treat almost all forms of
neurovascular compression syndromes and are found to be very
effective in controlling the pain and providing relief initially
includes [10]:
Carbamazepine is considered as the drug of choice because it
provides very good relief of symptoms initially. But adverse
effects such as hyponatremia are usually observed which may
necessitate the discontinuation of medication. Also this
medication provides relief of symptoms for very short period of
time. So, the affected patient would require operative procedures
for long term pain relief.
There are various major and minor surgical procedure known
which are employed to cure Neurovascular compression
syndromes for long term basis of pain relief. Among all the
surgical procedure known , Microvascular decompression surgery
[MVD] have shown the highest pain relief period of 12-15 years
or more. In 1967, Dr Peter Janetta have introduced this surgical
procedure and reported his study in ‘The New England Journal of
Medicine’ . It showed that initial success rate was 82% for
complete pain relief [11]. The main objective of MVD was to
separate the offending nerve from vascular structure by placement
of Teflon sponge. Teflon sponge isolates the nerve from pulsating
effect and pressure of blood vessels. There are very serious
complications of MVD widely reported for Trigeminal neuralgia
and Hemifacial spasm such as intracerebellar hematoma with
acute hydrocepahalus, status epilepticus , subarchnoid
hemorrhage and also possible infections of brain stem [12]. Also
Teflon could be one of the major causes of recurrence which have
been reported to cause a condition known as Teflon Granuloma
after 5-10 years of operation. Teflon Granuloma both clinically
and pathologically could emulate malignancy. There are also
some adverse reactions observed from Teflon such as frontalis
muscle suspension in TMJ surgery as well as pericardial closure
in rheumatic heart surgery [13].
So for proper cure of Neurovascular compression syndromes one
must aim at repositioning of affected cranial nerve with better
alternative which will not produce any adverse effects and would
cure permanently. Working hard on this specific disorder for
years observing and specifically working in innovation of better
alternative which would cure all forms of neurovascular
compression syndromes without any adverse outcomes and with
, SunText Rev Neurosci Psychol (2020), 1:3
Pandit M. Neurovascular Compression Syndromes: An Innovative Cure for Pain-Free Future. SunText Rev Neurosci Psychol 1(3):
null complications. I designed and invented a surgical implant
named as ‘MOLUMA’S’ Surgical Implant which would be able
to cure this disorder on permanent basis with very minimal
complications. This invention is named after my beloved parents
Moloy and Uma whom I want to express my heartiest gratitude
by curing and saving lives of sufferings. MOLUMA’S Surgical
Implant would be ensuring proper separation of offending
structures and will resist all forms of displacement along with
protecting the surrounding anatomical structures. MOLUMA’S
surgical procedure is designed on the bias of robotics which
would be able to resolve all complications and would produce the
best result in terms of permanent pain relief. I believe healthcare
facilities should be made accessible and affordable to every life
residing in perspective of cost. I am working; innovating,
improving and improvising more so that MOLUMA’S Surgical
Procedure would be cost-effective approach so that everyone
would be get treated from these severe painful disorders
efficiently and on permanent basis without any form of major
complications and recurrence.
Apart from cure of Neurovascular compression syndromes, I am
working in other fields of incurable disease and innovating their
cure on permanent basis with minimal complications and more
importantly making it very low cost effective ones, so that we
could proceed to an era of ‘disease-free’ world with no sufferings
from pain and where each and every one of us can get cured
permanently and lead rest our lives prosperously.
1. Neuro. Random House, inc. 2020
2. Baldauf J, Rosenstegel C, Schroeder H. Nerve compression
syndrome in posterior cranila fossa. Dtsch Aztebl Int. 2019;
116: 54-60.
3. ICHS Classification ICHD-3 .Defination of Trigeminal
Neuralgia. International Headache Society. 2004.
4. Mandybur G. Mayfield Clinic Health Info, Ohio. 2018.
5. Yaltho TC, Jankovic J. The many faces of hemifacial spasm;
differential diagnosis of unilateral facial spasm. Mov Disord.
2011; 1582-1592.
6. Fukushima T. Microvascular decompression for hemifacial
spasm: Result in 2890 cases. Neurovascular Surgery. New
York, Mcgraw-Hill. 1995; 1133-1145.
7. Shelat AM. Glosspharyngeal Neuralgia. Medline Plus. 2016.
8. Pecorra NC. Geniculate Neuralgia successfully treated with
Microvascular decompression. Interdisciplinary
Neurosurgey. 2020.
9. Brandt T, Strupp M, Dieterich M. Vestibular paraoxymia: a
treatable neurovascular cross-compression syndromes. J
Neurol. 2016; 263: 90-96.
10. Malik NA. Textbook of Oral and Maxillofacial Surgery.
11. Barker FG, Jannetta PJ, Bisonette DJ, Larkins MV. The long
term of Microvascular Decompression for Trigeminal
Neuralgia. The New England J Med. 1996; 334: 1077-1084.
12. Pabaney A. Micorvascular Decompression for Trigeminal
Neuralgia. Neurosurgical Atlas. 2020.
13. Chen J. Teflon granuloma after microvascular decompression
for trigeminal neuralgia. National Library of Medicine. 2000.
... Based on our review from history of trigeminal neuralgia to our modern day advancements we derived the fact that trigeminal neuralgia is caused by offendation of vascular structures, in majority of the cases it is being observed that Superior Cerebellar Artery is the main offending vascular structures which causes the compression on trigeminal nerve and causes the world's most excruciating pain humanity have ever witnessed. 11 ...
Full-text available
Our brain is the most complex organ in our body which conducts various complex functions and this level of complexity is operated by different structures of the brain. The complexity of relaying information between brain and different parts of the body is conducted by 12 pairs of cranial nerves. Out of 12 pairs of cranial nerves, the most complex and largest nerve is know as trigeminal nerve which is responsible for sensation of face and motor functions such as biting and chewing. Sometimes due to offendation of this nerve typically by Superior Cerebellar Artery leads to most excruciating painful disorder humanity have ever witnessed. : A systemic self-study was planned to determine and review with proper enlightenment on the existing facts to find the root sources of trigeminal neuralgia. This article discussed and focused on the exact cause of trigeminal neuralgia it’s association with Superior Cerebellar Artery along with descriptive analysis on the available treatments for this disorder. We concluded with the fact that based on our thorough review and analysis Superior Cerebellar Artery is the main artery which typically causes world’s most excruciating painful Suicide Disease.
Full-text available
The leading symptoms of vestibular paroxysmia (VP) are recurrent, spontaneous, short attacks of spinning or non-spinning vertigo that generally last less than one minute and occur in a series of up to 30 or more per day. VP may manifest when arteries in the cerebellar pontine angle cause a segmental, pressure-induced dysfunction of the eighth nerve. The symptoms are usually triggered by direct pulsatile compression with ephaptic discharges, less often by conduction blocks. MR imaging reveals the neurovascular compression of the eighth nerve (3D constructive interference in steady state and 3D time-of-flight sequences) in more than 95 % of cases. A loop of the anterior inferior cerebellar artery seems to be most often involved, less so the posterior inferior cerebellar artery, the vertebral artery, or a vein. The frequent attacks of vertigo respond to carbamazepine or oxcarbazepine, even in low dosages (200-600 mg/d or 300-900 mg/d, respectively), which have been shown to also be effective in children. Alternative drugs to try are lamotrigine, phenytoin, gabapentin, topiramate or baclofen or other non-antiepileptic drugs used in trigeminal neuralgia. The results of ongoing randomized placebo-controlled treatment studies, however, are not yet available. Surgical microvascular decompression of the eighth nerve is the "ultima ratio" for medically intractable cases or in exceptional cases of non-vascular compression of the eighth nerve by a tumor or cyst. The International Barany Society for Neuro-Otology is currently working on a consensus document on the clinical criteria for establishing a diagnosis of VP as a clinical entity.
Full-text available
An analysis of 57 patients with trigeminal neuralgia (TN) treated with microvascular decompression (MVD) is presented. Mean follow-up time was 3.1 years. Vascular compression of the trigeminal nerve root was noted in 54 cases. In the remaining 3 patients, adhesions were observed in two, whereas no obvious cause was found in one case. Among the patients with vascular compression, 43 (80%) became painfree immediately after surgery, and have remained so during the observation period. There was an indisputable relationship between the degree of observed vascular compression of the nerve and longterm complete pain relief. There was no mortality in association with the surgery. Major morbidity was seen in 3.6%, and partial facial sensory loss was seen in seven patients (12%). The implications of these findings are discussed.
Objective: To investigate operative efficacy, surgical complication rate and surgical strategy of microvascular decompression (MVD) for hemifacial spasm (HFS). Methods: The clinical data of 46 patients with HFS were retrospectively analysed. All patients underwent MVD. Results: During operation, it was found that the facial nerve root exit zone (RExZ) was compressed by arterial vessels, namely anterior inferior cerebellar artery (AICA) in 24 cases (52.17%), posterior inferior cerebellar artery (PICA) in 14 cases (30.43%), vertebral artery and small artery in 7 cases (15.22%), and vertebral artery in one case (2.18%). Symptoms in 38 patients were completely remitted immediately after surgery, and symptoms of 8 cases were reduced significantly. The main complications included dizziness and tinnitus in 9 cases, hearing loss in 5 cases, cerebrospinal fluid leakage in one case, and infection in 2 cases. No patient died during operation. Conclusion: Microvascular decompression is the first choice for treating idiopathic hemifacial spasm. Skilled microsurgical techniques, and identification and complete decompression of the responsible artery are the key to ensure success in microvascular decompression.
Hemifacial spasm is defined as unilateral, involuntary, irregular clonic or tonic movement of muscles innervated by the seventh cranial nerve. Most frequently attributed to vascular loop compression at the root exit zone of the facial nerve, there are many other etiologies of unilateral facial movements that must be considered in the differential diagnosis of hemifacial spasm. The primary purpose of this review is to draw attention to the marked heterogeneity of unilateral facial spasms and to focus on clinical characteristics of mimickers of hemifacial spasm and on atypical presentations of nonvascular cases. In addition to a comprehensive review of the literature on hemifacial spasm, medical records and videos of consecutive patients referred to the Movement Disorders Clinic at Baylor College of Medicine for hemifacial spasm between 2000 and 2010 were reviewed, and videos of illustrative cases were edited. Among 215 patients referred for evaluation of hemifacial spasm, 133 (62%) were classified as primary or idiopathic hemifacial spasm (presumably caused by vascular compression of the ipsilateral facial nerve), and 4 (2%) had hereditary hemifacial spasm. Secondary causes were found in 40 patients (19%) and included Bell's palsy (n=23, 11%), facial nerve injury (n=13, 6%), demyelination (n=2), and brain vascular insults (n=2). There were an additional 38 patients (18%) with hemifacial spasm mimickers classified as psychogenic, tics, dystonia, myoclonus, and hemimasticatory spasm. We concluded that although most cases of hemifacial spasm are idiopathic and probably caused by vascular compression of the facial nerve, other etiologies should be considered in the differential diagnosis, particularly if there are atypical features.
Our purpose was to research the factors that may induce Teflon granuloma in trigeminal neuralgia patients who have undergone microvascular decompression (MVD) procedures, to propose methods for the early diagnosis of Teflon granuloma, and provide suggestions for reducing this complication. From 1985 to 1996, 89 trigeminal neuralgia patients underwent MVD with Teflon felt to separate the offending vessels and the trigeminal nerve. Ten patients had secondary explorations for recurrent symptoms. Five patients developed recurrent facial pain associated with facial numbness within a certain period after the first operation. We reviewed the onset and site of the initial symptoms, the duration of the symptoms, the operative findings and methods, and the results of the operations. In the reoperative patients, we analyzed the initial and secondary symptoms after the first operation, and the time to relapse. We compared the operative findings and methods in these operations. The operative findings in the 10 patients with recurrence were Teflon granuloma in five patients, arterial loop compression in three patients, venous compression in one patient, and negative exploration in one patient. The Teflon granuloma patients all complained of facial numbness after the first MVD operation. The incidence of Teflon granuloma after MVD was 5.6% (5/89). The Teflon felt used in the MVD procedure can produce complications. It is not absolutely inert when used in MVD procedures. When it contacts the tentorium and/or dura, an inflammatory giant-cell foreign body reaction can be induced. In the future, we should search for other implants to replace the Teflon felt. However, until new materials are found, we suggest that the Teflon felt be kept away from the tentorium and dura and placed completely within the CSF cisterna. We can diagnose Teflon granuloma early with enhanced CT and/or MRI, especially in patients with new facial numbness symptoms after Teflon MVD procedures. The results of reexploration of Teflon granulomas are more satisfactory than a negative exploration or venous compression. We may be able to decrease the incidence of Teflon granuloma. We should be more aggressive in performing reexploration in these recurrent patients.
Nerve compression syndrome in posterior cranila fossa
  • J Baldauf
  • C Rosenstegel
  • H Schroeder
Baldauf J, Rosenstegel C, Schroeder H. Nerve compression syndrome in posterior cranila fossa. Dtsch Aztebl Int. 2019; 116: 54-60.
Mayfield Clinic Health Info
  • G Mandybur
Mandybur G. Mayfield Clinic Health Info, Ohio. 2018.
Geniculate Neuralgia successfully treated with Microvascular decompression. Interdisciplinary Neurosurgey
  • N C Pecorra
Pecorra NC. Geniculate Neuralgia successfully treated with Microvascular decompression. Interdisciplinary Neurosurgey. 2020.
Textbook of Oral and Maxillofacial Surgery
  • N A Malik
Malik NA. Textbook of Oral and Maxillofacial Surgery.
The long term of Microvascular Decompression for Trigeminal Neuralgia. The New England
  • F G Barker
  • P J Jannetta
  • D J Bisonette
  • M V Larkins
Barker FG, Jannetta PJ, Bisonette DJ, Larkins MV. The long term of Microvascular Decompression for Trigeminal Neuralgia. The New England J Med. 1996; 334: 1077-1084.