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Nerve Compression Syndromes in the Posterior Cranial Fossa.
Dtsch Arztebl Int 2019; 116(4):54-60DA

Abstract

BACKGROUND

Nerve compression syndromes in the posterior cranial fossa can severely impair patients' quality of life. There is often uncertainty about the best treatment. In this article, we provide an overview of these conditions and the corresponding treatment strategies.

METHODS

This review is based on pertinent publications retrieved by a selective search in PubMed and on a scientific analysis of the authors' patient collective.

RESULTS

These syndromes are caused by compression of a cranial nerve by an artery or vein at the zone of the nerve's entry to or exit from the brainstem. The best-known neurovascular compression syndrome is trigeminal neuralgia, followed by hemifacial spasm. Less well known are glossopharyngeal neuralgia, nervus intermedius neuralgia, and vestibular paroxysmia. The initial treatment of trigeminal neuralgia is medical: the first line of treatment is with sodium-blocking anticon- vulsants, such as carbamazepine. For patients with hemifacial spasm, botulinum toxin injection is the recommended initial treatment and often leads to a satisfactory regression of the spasms. If these treatments fail, a microvascular decompression operation is indicated. The aim of the procedure is to separate the irritating vessel from the nerve and to keep these structures apart permanently. There is hardly any available evidence on these treatment strategies from randomized controlled trials.

CONCLUSION

Nerve compression syndromes in the posterior cranial fossa can generally be treated nonsurgically at first. Over the course of the condition, however, treatment failure or intolerable side effects may arise. In such cases, a microvascu- lar decompression operation is indicated. This is a causally directed form of treat- ment that generally yields very good results.

Authors+Show Affiliations

Department of Neurosurgery, University Medicine Greifswald.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30855007

Citation

Baldauf, Jörg, et al. "Nerve Compression Syndromes in the Posterior Cranial Fossa." Deutsches Arzteblatt International, vol. 116, no. 4, 2019, pp. 54-60.
Baldauf J, Rosenstengel C, Schroeder HWS. Nerve Compression Syndromes in the Posterior Cranial Fossa. Dtsch Arztebl Int. 2019;116(4):54-60.
Baldauf, J., Rosenstengel, C., & Schroeder, H. W. S. (2019). Nerve Compression Syndromes in the Posterior Cranial Fossa. Deutsches Arzteblatt International, 116(4), pp. 54-60. doi:10.3238/arztebl.2019.0054.
Baldauf J, Rosenstengel C, Schroeder HWS. Nerve Compression Syndromes in the Posterior Cranial Fossa. Dtsch Arztebl Int. 2019 01 25;116(4):54-60. PubMed PMID: 30855007.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nerve Compression Syndromes in the Posterior Cranial Fossa. AU - Baldauf,Jörg, AU - Rosenstengel,Christian, AU - Schroeder,Henry W S, PY - 2018/03/29/received PY - 2018/03/29/revised PY - 2018/10/04/accepted PY - 2019/3/12/entrez PY - 2019/3/12/pubmed PY - 2019/3/12/medline SP - 54 EP - 60 JF - Deutsches Arzteblatt international JO - Dtsch Arztebl Int VL - 116 IS - 4 N2 - BACKGROUND: Nerve compression syndromes in the posterior cranial fossa can severely impair patients' quality of life. There is often uncertainty about the best treatment. In this article, we provide an overview of these conditions and the corresponding treatment strategies. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed and on a scientific analysis of the authors' patient collective. RESULTS: These syndromes are caused by compression of a cranial nerve by an artery or vein at the zone of the nerve's entry to or exit from the brainstem. The best-known neurovascular compression syndrome is trigeminal neuralgia, followed by hemifacial spasm. Less well known are glossopharyngeal neuralgia, nervus intermedius neuralgia, and vestibular paroxysmia. The initial treatment of trigeminal neuralgia is medical: the first line of treatment is with sodium-blocking anticon- vulsants, such as carbamazepine. For patients with hemifacial spasm, botulinum toxin injection is the recommended initial treatment and often leads to a satisfactory regression of the spasms. If these treatments fail, a microvascular decompression operation is indicated. The aim of the procedure is to separate the irritating vessel from the nerve and to keep these structures apart permanently. There is hardly any available evidence on these treatment strategies from randomized controlled trials. CONCLUSION: Nerve compression syndromes in the posterior cranial fossa can generally be treated nonsurgically at first. Over the course of the condition, however, treatment failure or intolerable side effects may arise. In such cases, a microvascu- lar decompression operation is indicated. This is a causally directed form of treat- ment that generally yields very good results. SN - 1866-0452 UR - https://www.unboundmedicine.com/medline/citation/30855007/Nerve_Compression_Syndromes_in_the_Posterior_Cranial_Fossa L2 - https://doi.org/10.3238/arztebl.2019.0054 DB - PRIME DP - Unbound Medicine ER -