Neurosurg Focus 59(3):E6, 2025
Microvascular decompression (MVD) is the most effective treatment for trigeminal neuralgia and hemifacial spasm caused by vertebrobasilar dolichoectasia, offering higher symptom resolution and lower recurrence than radiosurgery or medication. Endoscope-assisted MVD reduces complications. Interposition and transposition surgical techniques show similar efficacy and recurrence rates.
• Vertebrobasilar dolichoectasia (VBD) is a rare vascular disorder that can compress cranial nerves, most commonly causing trigeminal neuralgia (TN) and hemifacial spasm (HFS).
• Microvascular decompression (MVD) is the most effective treatment, achieving symptom resolution in 87.3% of cases and having the lowest recurrence rate (6.5%) compared to radiosurgery and medication.
• Radiosurgery offers symptom relief in 63.7% of patients but has a high recurrence rate (47.2%) and is mainly used when surgery is contraindicated.
• Endoscope-assisted MVD significantly reduces complication rates (5.3% vs 23.8% with microscope) but does not improve symptom resolution compared to microscope-assisted surgery.
• Interposition and transposition techniques for nerve decompression show similar efficacy and recurrence rates, with no significant differences in complications.
• Nonsurgical treatments (medication, botulinum toxin, etc.) rarely result in full symptom resolution and are generally insufficient as standalone therapies.
• Multiple vessels (AICA, PICA, SCA) can be involved in nerve compression in VBD, affecting surgical planning and outcomes.
• Most patients experience long delays (mean 4–4.5 years) before diagnosis, and VBD-related cranial neuropathies remain challenging to manage due to anatomical complexity and limited high-quality evidence.
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