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Microvascular Compression of the Vestibulocochlear Nerve

  • Dirk De RidderEmail author
  • Aage R. Møller

Keypoints

  1. 1.

    Microvascular contacts or compressions of the vestibulocochlear nerve can result in tinnitus.

     
  2. 2.

    For nonpulsatile tinnitus, the contact is most often at the central nervous system segment.

     
  3. 3.
    For pulsatile tinnitus and typewriter tinnitus, the contact is at the peripheral nervous system segment. The tinnitus is unilateral and characterized by intermittent paroxysms of tinnitus.
    1. (a)

      A typical development consists of progressively more frequent bouts of tinnitus, which last longer and longer.

       
    2. (b)

      If bilateral vascular compressions exist, the tinnitus alternates between the left and right side, and does not occur on each side simultaneously.

       
    3. 4.

      Associated symptoms are correlated with related contacts/compressions of nearby nerves and include overt or cryptogenic hemifacial spasms, geniculate neuralgia, optokinetically induced short bouts of disabling positional vertigo, and tinnitus frequency-specific hearing loss.

       
    4. 5.
      Auditory brainstem responses (ABRs) correlate with disease progress and clinical symptoms and can be used diagnostically.
      1. (a)

        Tinnitus is causally related to a decrease in amplitude of peak II in the ipsilaterally elicited ABR.

         
      2. (b)

        Tinnitus frequency-specific hearing loss is causally related to prolongation of the ipsilateral interpeak latency (IPL) I–III.

         
      3. (c)

        Prolongation of contralateral IPL III–V occurs and is a sign of slowed signal transmission in the brainstem.

         
       
    5. 6.

      Magnetic resonance imaging sequences with constructive interference in steady state can visualize most vascular contacts/compressions of the auditory nerve.

       
    6. 7.

      Microvascular decompression should be performed before irreversible nerve damage is induced; clinically, the procedure should be performed before 4–5 years.

       
     

Keywords

Pulsatile Tinnitus Vascular conflict Microvascular compression MVC MVD 

Abbreviations

AAO

American Academy of Otolaryngology

AAOO

American Academy of Ophthalmology and Otolaryngology

ABR

Auditory brainstem response

CISS

Constructive interference in steady state

CVCS

Cochleovestibular compression syndrome

ENT

Ear nose and throat

HFS

Hemifacial spasm

IPL

Interpeak latency

MRI

Magnetic resonance imaging

MVC

Microvascular compression

MVD

Microvascular decompression

PNS

Peripheral nervous system

TGN

Trigeminal neuralgia

References

  1. 1.
    Møller AR (1991) The cranial nerve vascular compression syndrome: II. A review of pathophysiology. Acta Neurochir (Wien) 113:24–30.CrossRefGoogle Scholar
  2. 2.
    Jannetta PJ (1975) Neurovascular cross-compression in patients with hyperactive dysfunction symptoms of the eighth cranial nerve. Surg Forum 26:467–9.PubMedGoogle Scholar
  3. 3.
    Rosetti P, NO Ben Taib, J Brotchi et al (1999) Arnold Chiari Type I malformation presenting as a trigeminal neuralgia: case report. Neurosurgery 44:1122–3; discussion 3–4.Google Scholar
  4. 4.
    Sindou M (1999) discussion on Arnold Chiari Type I malformation presenting as a trigeminal neuralgia: case report. Neurosurgery 44:1123–4.CrossRefGoogle Scholar
  5. 5.
    Kanpolat Y, A Unlu, A Savas et al (2001) Chiari Type I malformation presenting as glossopharyngeal neuralgia: case report. Neurosurgery 48:226–8.PubMedGoogle Scholar
  6. 6.
    Glocker FX, JK Krauss, G Deuschl et al (1998) Hemifacial spasm due to posterior fossa tumors: the impact of tumor location on electrophysiological findings. Clin Neurol Neurosurg 100:104–11.PubMedCrossRefGoogle Scholar
  7. 7.
    Barker FG II, PJ Jannetta, RP Babu et al (1996) Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors. J Neurosurg 84:818–25.PubMedCrossRefGoogle Scholar
  8. 8.
    De Ridder D, T Menovsky, C Van Laer et al (2008) Remote tentorium meningioma causing sudden sensorineural deafness. Surg Neurol 70:312–7; discussion 318.Google Scholar
  9. 9.
    Matsuura N and A Kondo (1996) Trigeminal neuralgia and hemifacial spasm as false localizing signs in patients with a contralateral mass of the posterior cranial fossa. Report of three cases. J Neurosurg 84:1067–71.PubMedCrossRefGoogle Scholar
  10. 10.
    Cappabianca P, G Mariniello, A Alfieri et al (1997) Trigeminal neuralgia and contralateral mass. J Neurosurg 86:171–2.PubMedGoogle Scholar
  11. 11.
    Haddad FS and JM Taha (1990) An unusual cause for trigeminal neuralgia: contralateral meningioma of the posterior fossa. Neurosurgery 26:1033–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Koenig M, K Kalyan-Raman and ON Sureka (1984) Contralateral trigeminal nerve dysfunction as a false localizing sign in acoustic neuroma: a clinical and electrophysiological study. Neurosurgery 14:335–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Mase G, M Zorzon, L Capus et al (1994) Trigeminal neuralgia due to contralateral meningioma of the posterior cranial fossa. J Neurol Neurosurg Psychiatry 57:1010.PubMedCrossRefGoogle Scholar
  14. 14.
    Sindou M, T Howeidy and G Acevedo (2002) Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia (with correlations between topography of pain and site of the neurovascular conflict). Prospective study in a series of 579 patients. Acta Neurochir (Wien) 144:1–12; discussion 143.Google Scholar
  15. 15.
    Jho HD and PJ Jannetta (1995) Microvascular decompression for spasmodic torticollis. Acta Neurochir (Wien) 134:21–6.CrossRefGoogle Scholar
  16. 16.
    Kommerell G, E Mehdorn and UP Ketelsen (1985) Oculomotor paralysis with cyclic spasms; electromyographic and electron microscopic indications of chronic peripheral nerve irritation. Fortschr Ophthalmol 82: 203–4.PubMedGoogle Scholar
  17. 17.
    Samii M, SK Rosahl, GA Carvalho et al (1998) Microvascular decompression for superior oblique myokymia: first experience. Case report. J Neurosurg 89:1020–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Scharwey K, T Krzizok, M Samii et al (2000) Remission of superior oblique myokymia after microvascular decompression. Ophthalmologica 214:426–8.PubMedCrossRefGoogle Scholar
  19. 19.
    De Ridder D and T Menovsky (2007) Neurovascular compression of the abducent nerve causing abducent palsy treated by microvascular decompression. Case report. J Neurosurg 107:1231–4.PubMedCrossRefGoogle Scholar
  20. 20.
    De Ridder D, A Møller, J Verlooy et al (2002) Is the root entry/exit zone important in microvascular compression syndromes? Neurosurgery 51:427–33; discussion 33–4.Google Scholar
  21. 21.
    Resnick DK, PJ Jannetta, D Bissonnette et al (1995) Microvascular decompression for glossopharyngeal neuralgia. Neurosurgery 36:64–8; discussion 8–9.Google Scholar
  22. 22.
    Lovely TJ and PJ Jannetta (1997) Surgical management of geniculate neuralgia. Am J Otol 18:512–7.PubMedGoogle Scholar
  23. 23.
    Fukushima T (1995) Microvascular decompression for hemifacial spasm: result in 2890 cases. In Neurovascular surgery, L Carter, R Spetzler and M Hamilton, Editors. McGraw-Hill, Inc: New York, 1133–45Google Scholar
  24. 24.
    Kobata H, A Kondo, K Iwasaki et al (1998) Combined hyperactive dysfunction syndrome of the cranial nerves: trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia: 11-year experience and review. Neurosurgery 43:1351–61; discussion 61–2.Google Scholar
  25. 25.
    Møller MB, AR Møller, PJ Jannetta et al (1993) Microvascular decompression of the eighth nerve in patients with disabling positional vertigo: selection criteria and operative results in 207 patients. Acta Neurochir (Wien) 125:75–82.CrossRefGoogle Scholar
  26. 26.
    Burchiel KJ and KV Slavin (2000) On the natural history of trigeminal neuralgia. Neurosurgery 46:152–4; discussion 4–5.Google Scholar
  27. 27.
    Ehni G and H Woltman (1945) Hemifacial spasm. Arch Neurol Psychiatry 53:205–11.CrossRefGoogle Scholar
  28. 28.
    Ryu H, S Yamamoto, K Sugiyama et al (1998) Neurovascular compression syndrome of the eighth cranial nerve. What are the most reliable diagnostic signs? Acta Neurochir (Wien) 140:1279–86.CrossRefGoogle Scholar
  29. 29.
    Møller MB (1990) Results of microvascular decompression of the eighth nerve as treatment for disabling positional vertigo. Ann Otol Rhinol Laryngol 99:724–9.PubMedGoogle Scholar
  30. 30.
    Møller MB, AR Møller, PJ Jannetta et al (1993) Vascular decompression surgery for severe tinnitus: selection criteria and results. Laryngoscope 103:421–7.PubMedCrossRefGoogle Scholar
  31. 31.
    De Ridder D, H Ryu, AR Møller et al (2004) Functional anatomy of the human cochlear nerve and its role in microvascular decompressions for tinnitus. Neurosurgery 54:381–8; discussion 8–90.Google Scholar
  32. 32.
    Okamura T, Y Kurokawa, N Ikeda et al (2000) Microvascular decompression for cochlear symptoms. J Neurosurg 93:421–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Pollack IF, PJ Jannetta and DJ Bissonette (1988) Bilateral trigeminal neuralgia: a 14-year experience with microvascular decompression. J Neurosurg 68:559–65.PubMedCrossRefGoogle Scholar
  34. 34.
    Rushton JG, JC Stevens and RH Miller (1981) Glossopharyngeal (vagoglossopharyngeal) neuralgia: a study of 217 cases. Arch Neurol 38:201–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Tacconi L and JB Miles (2000) Bilateral trigeminal neuralgia: a therapeutic dilemma. Br J Neurosurg 14:33–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Brisman R (1987) Bilateral trigeminal neuralgia. J Neurosurg 67:44–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Fonoff ET, VP Araujo, YS de Oliveira et al (2009) Neurovascular compression in painful tic convulsif. Acta Neurochir (Wien) 151:989–93.CrossRefGoogle Scholar
  38. 38.
    Cook BR and PJ Jannetta (1984) Tic convulsif: results in 11 cases treated with microvascular decompression of the fifth and seventh cranial nerves. J Neurosurg 61:949–51.PubMedCrossRefGoogle Scholar
  39. 39.
    Felicio AC, O Godeiro Cde, Jr., V Borges et al (2007) Bilateral hemifacial spasm and trigeminal neuralgia: a unique form of painful tic convulsif. Mov Disord 22:285–6.PubMedCrossRefGoogle Scholar
  40. 40.
    Chadha NK and GM Weiner (2008) Vascular loops causing otological symptoms: a systematic review and meta-analysis. Clin Otolaryngol 33:5–11.PubMedCrossRefGoogle Scholar
  41. 41.
    Nowe V, D De Ridder, PH Van de Heyning et al (2004) Does the location of a vascular loop in the cerebellopontine angle explain pulsatile and non-pulsatile tinnitus? Eur Radiol 14:2282–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Jannetta PJ (1977) Observations on the etiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia. Definitive microsurgical treatment and results in 117 patients. Neurochirurgia (Stuttg) 20:145–54.Google Scholar
  43. 43.
    Levine RA (2006) Typewriter tinnitus: a carbamazepine-responsive syndrome related to auditory nerve vascular compression. ORL J Otorhinolaryngol Relat Spec 68:43–6; discussion 6–7.Google Scholar
  44. 44.
    De Ridder D, L De Ridder, V Nowe et al (2005) Pulsatile tinnitus and the intrameatal vascular loop: why do we not hear our carotids? Neurosurgery 57:1213–7; discussion 1217.Google Scholar
  45. 45.
    Jannetta PJ and DJ Bissonette (1978) Bell’s palsy: a theory as to etiology. Observations in six patients. Laryngoscope 88:849–54.PubMedGoogle Scholar
  46. 46.
    Schwaber MK and JW Hall (1992) Cochleovestibular nerve compression syndrome. I. Clinical features and audiovestibular findings. Laryngoscope 102:1020–9.PubMedGoogle Scholar
  47. 47.
    Møller MB (1988) Controversy in ménière’s disease: results of microvascular decompression of the eighth nerve. Am J Otol 9:60–3.PubMedGoogle Scholar
  48. 48.
    Møller AR (1993) Cranial nerve dysfunction syndromes: Pathophysiology of microvascular compression. In: Neuro surgical Topics Book 13, ‘Surgery of Cranial Nerves of the Posterior Fossa,’ Chapter 2. D.L. Barrow, ed. American Association of Neurological Surgeons, Park Ridge, Illinois, pp. 105–129.Google Scholar
  49. 49.
    Møller AR and PJ Jannetta (1985) Hemifacial spasm: results of electrophysiologic recording during microvascular decompression operations. Neurology 35:969–74.PubMedCrossRefGoogle Scholar
  50. 50.
    Møller MB and AR Møller (1985) Audiometric abnormalities in hemifacial spasm. Audiology 24:396–405.PubMedCrossRefGoogle Scholar
  51. 51.
    CHE A-H (1995) Committee on hearing and equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere’s disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg 113:181–5.CrossRefGoogle Scholar
  52. 52.
    Beasley NJ and NS Jones (1996) Meniere’s disease: evolution of a definition. J Laryngol Otol 110:1107–13.PubMedGoogle Scholar
  53. 53.
    De Ridder D, K Heijneman, B Haarman et al (2007) Tinnitus in vascular conflict of the eighth cranial nerve: a surgical pathophysiological approach to ABR changes. Prog Brain Res 166:401–11.PubMedCrossRefGoogle Scholar
  54. 54.
    Hamlyn PJ (1999) Neurovascular compression of the cranial nerves in neurological and systemic disease. Elsevier: Amsterdam.Google Scholar
  55. 55.
    Spoendlin H and A Schrott (1988) The spiral ganglion and the innervation of the human organ of Corti. Acta Otolaryngol 105:403–10.PubMedCrossRefGoogle Scholar
  56. 56.
    Spoendlin H and A Schrott (1990) Quantitative evaluation of the human cochlear nerve. Acta Otolaryngol Suppl 470:61–9; discussion 69–70.Google Scholar
  57. 57.
    Felix H, LG Johnsson, MJ Gleeson et al (1992) Morphometric analysis of the cochlear nerve in man. Acta Otolaryngol 112:284–7.PubMedGoogle Scholar
  58. 58.
    Nguyen BH, E Javel and SC Levine (1999) Physiologic identification of eighth nerve subdivisions: direct recordings with bipolar and monopolar electrodes. Am J Otol 20:522–34.PubMedGoogle Scholar
  59. 59.
    Møller AR (2000) Hearing: its physiology and pathophysiology. Academic Press: San Diego.Google Scholar
  60. 60.
    Bear M, BW Connors and M Paradiso (2001) Neuroscience: exploring the brain. Lippincott Williams and Wilkins: Baltimore, 349–95.Google Scholar
  61. 61.
    Purves D, G Augustine, D Fitzpatrick et al (1997) Neuroscience. Sinauer Associates: Sunderland, 223–44.Google Scholar
  62. 62.
    Shepherd G (1994) Neurobiology. Oxford University Press: New York.Google Scholar
  63. 63.
    Sando I (1965) The anatomical interrelationships of the cochlear nerve fibers. Acta Otolaryng (Stockh) 59:417–36.CrossRefGoogle Scholar
  64. 64.
    Silverstein H, H Norrell, T Haberkamp et al (1986) The unrecognized rotation of the vestibular and cochlear nerves from the labyrinth to the brain stem: its implications to surgery of the eighth cranial nerve. Otolaryngol Head Neck Surg 95:543–9.PubMedGoogle Scholar
  65. 65.
    Casselman JW, R Kuhweide, M Deimling et al (1993) Constructive interference in steady state-3DFT MR imaging of the inner ear and cerebellopontine angle. AJNR Am J Neuroradiol 14:47–57.PubMedGoogle Scholar
  66. 66.
    Nowe V, JL Michiels, R Salgado et al (2004) High-resolution virtual MR endoscopy of the cerebellopontine angle. AJR Am J Roentgenol 182:379–84.PubMedGoogle Scholar
  67. 67.
    Jannetta PJ (1983) Hemifacial spasm: treatment by posterior fossa surgery. J Neurol Neurosurg Psychiatry 46:465–6.PubMedCrossRefGoogle Scholar
  68. 68.
    Møller AR (1999) Vascular compression of cranial nerves: II: pathophysiology. Neurol Res 21:439–43.PubMedGoogle Scholar
  69. 69.
    Wilkins RH (1985) Neurovascular compression syndromes. Neurol Clin 3:359–72.PubMedGoogle Scholar
  70. 70.
    Dandy W (1934) Concerning the cause of trigeminal neuralgia. Am J Surg 24:447–55.CrossRefGoogle Scholar
  71. 71.
    Love S and HB Coakham (2001) Trigeminal neuralgia: pathology and pathogenesis. Brain 124:2347–60.PubMedCrossRefGoogle Scholar
  72. 72.
    Eidelman BH, VK Nielsen, M Møller et al (1985) Vascular compression, hemifacial spasm, and multiple cranial neuropathy. Neurology 35:712–6.PubMedCrossRefGoogle Scholar
  73. 73.
    Schwaber M (1994) Vascular compression syndromes. In Neurotology, R Jackler and D Brackmann, Editors. Mosby: St Louis, 881–903.Google Scholar
  74. 74.
    van der Loo E, S Gais, M Congedo et al (2009) Tinnitus intensity dependent gamma oscillations of the contralateral auditory cortex. PLoS One 4:e7396.PubMedCrossRefGoogle Scholar
  75. 75.
    Weisz N, S Muller, W Schlee et al (2007) The neural code of auditory phantom perception. J Neurosci 27:1479–84.PubMedCrossRefGoogle Scholar
  76. 76.
    Møller AR (2006) Hearing: anatomy, physiology, and disorders of the auditory system, 2nd Ed. Academic Press: Amsterdam.Google Scholar
  77. 77.
    Møller AR, MB Møller, PJ Jannetta et al (1992) Compound action potentials recorded from the exposed eighth nerve in patients with intractable tinnitus. Laryngoscope 102:187–97.PubMedGoogle Scholar
  78. 78.
    Jastreboff PJ (1990) Phantom auditory perception (tinnitus): mechanisms of generation and perception. Neurosci Res 8:221–54.PubMedCrossRefGoogle Scholar
  79. 79.
    De Ridder D (2004) Modulation of brain functions in tinnitus. Neuromodulation 7:146.CrossRefGoogle Scholar
  80. 80.
    De Ridder D, H Ryu, G De Mulder et al (2005) Frequency specific hearing improvement in microvascular decompression of the cochlear nerve Acta Neurochir (Wien) 147:495–501.CrossRefGoogle Scholar
  81. 81.
    Norena A, C Micheyl, S Chery-Croze et al (2002) Psychoacoustic characterization of the tinnitus spectrum: implications for the underlying mechanisms of tinnitus. Audiol Neurootol 7:358–69.PubMedCrossRefGoogle Scholar
  82. 82.
    Schlee W, T Hartmann, B Langguth et al (2009) Abnormal resting-state cortical coupling in chronic tinnitus. BMC Neurosci 10:11.PubMedCrossRefGoogle Scholar
  83. 83.
    Jannetta P (1997) Outcome after microvascular decompression for typical trigeminal neuralgia, hemifacial spasm, tinnitus, disabling positional vertigo, and glossopharyngeal neuralgia. In Clinical neurosurgery, S Grady, Editor. Williams and Wilkins: Baltimore, 331–84.Google Scholar
  84. 84.
    Brookes GB (1996) Vascular-decompression surgery for severe tinnitus. Am J Otol 17:569–76.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.BRAI2N and Department of Neurosurgery, TRI Tinnitus Clinic AntwerpUniversity of AntwerpEdegemBelgium

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