title: Microvascular decompression in patients with coexistent trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia.
abstract: BACKGROUND
  Trigeminal neuralgia(TN), hemifacial spasm (HFS) and glossopharyngeal neuralgia (GPN) were referred to hyperactive dysfunction syndromes (HDSs) of the cranial nerves. These symptoms may occur synchronously or metachronously, but the combination of three diseases is extremely rare.
  
  
  METHODS
  From 2007 through 2013, six patients with coexistent GPN-HFS-TN were treated in our department. The combined symptoms occurred on the same side in three and on both sides in three. These patients underwent nine microvascular decompression (MVD) procedures in total. The clinical data including operative findings were respectively analyzed, and the etiological factors as well as treatment strategies were discussed.
  
  
  RESULTS
  Intraoperatively, in all the cases a small posterior fossa was found, which was crowded with cranial nerve roots and cerbellar vesels. Postoperatively, spasm was stopped immediately in four and within 3 months in two; the symptom of TN disappeared immediately in four and within 2 weeks in two; the symptom of GPN was relieved immediately in four and improved with medication in two. During the up to 77 months' follow-up, no changes, recurrence or any dysfunctions of cranial nerves were observed in any of the patients.
  
  
  CONCLUSIONS
  The combination of HFS-TN-GPN is extremely rare and is often associated with a looped VBA and a smaller posterior fossa. However, MVD is still a good choice for treatment. To achieve a safe and effective outcome, dissection of the caudal cranial nerves and proximal transposition of the vertebral artery before decompression of the affected nerve roots are strongly recommended.
authors.affiliation: Department of Neurosrugery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, 200092, China, hnwang_2010@126.com.
authors.forename: Yong-Nan
authors.initials: YN
authors.lastname: Wang
authors.forename: Jun
authors.initials: J
authors.lastname: Zhong
authors.forename: Jin
authors.initials: J
authors.lastname: Zhu
authors.forename: Ning-Ning
authors.initials: NN
authors.lastname: Dou
authors.forename: Lei
authors.initials: L
authors.lastname: Xia
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Visocchi
authors.forename: Shi-Ting
authors.initials: ST
authors.lastname: Li
mesh_terms: D000368:Aged; D001488:Basilar Artery / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D020435:Glossopharyngeal Nerve Diseases / Q000150:complications / Q000601:surgery*; D019569:Hemifacial Spasm / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery / Q000379:methods*; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000150:complications / Q000601:surgery*; D014711:Vertebral Artery / Q000601:surgery*