Microvascular decompression: a contemporary update

Okon I.I. Menon S.S. Osama M. Aiman M. Paleare L.F.F. Eliseo D.L.-P., III Shafqat M.D. Ezeaku C.O. Ferreira M.Y. Razouqi Y. Kapsetaki M. Saniel J.D.R. Panit N.M. Rao A.G. Iqbal U. Otobo D.D. Alkhawaldeh I.M. Pereira F.S. Akbar I. Kasimieh O. Chaurasia B.
December 2025 BioMed Central Ltd

BMC Surgery
2025 #25 Issue 1

Background: Microvascular decompression (MVD) is the gold-standard surgical treatment for cranial nerve compression disorders, including trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GPN). This review synthesizes historical milestones, recent advances, and evolving techniques in MVD, with a primary focus on these conditions. Methods: A comprehensive literature review was conducted using databases such as PubMed, SpringerLink, Google Scholar, BioMed Central, Scopus, and ScienceDirect. Studies published between 1970 and 2024 were analyzed, emphasizing surgical techniques, clinical outcomes, and technological innovations in MVD. Articles addressing TN, HFS, GPN, and other cranial nerve disorders treated with MVD were selected for detailed evaluation. Results: MVD demonstrates high efficacy, with 80–90% of patients achieving immediate symptom relief. Nevertheless, 15–25% of patients experience symptom recurrence, though long-term outcomes remain favorable. Fully endoscopic MVD has shown potential for enhanced intraoperative visualization, particularly in complex anatomical regions; however, its impact on surgical precision and clinical outcomes is still under investigation. Moreover, innovations in visualization technologies, including three-dimensional exoscopic systems and artificial intelligence-assisted surgery, continue to improve procedural safety and outcomes. Despite these advancements, complications such as hearing loss (1–2%) and cerebrospinal fluid leakage (2–4%) persist, highlighting the need for continuous refinement of techniques. Conclusions: MVD is evolving with the integration of cutting-edge technologies, resulting in improved clinical outcomes and reduced complication rates. Emerging innovations such as robotic-assisted MVD and gene therapies for cranial nerve disorders, including TN and GPN, promise even greater efficacy and precision. However, further research is necessary to standardize surgical protocols and address disparities in healthcare systems globally.

Contemporary update , Glossopharyngeal neuralgia , Hemifacial spasm , Microvascular decompression , Trigeminal neuralgia

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Department of Research, Medical Research Circle (MedReC), DR, Bukavu, Congo
University College London Medical School, 74 Huntley St, Bloomsbury, London, WC1E 6DE, United Kingdom
Department of Neurosurgery, Yeditepe University, Istanbul, Turkey
Department of Vascular Neurosurgery, National Centre for Neurosurgery, Astana, Kazakhstan
Pontifical Catholic University of Paraná, PR, Curitiba, Brazil
Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
Office for Research, Innovation and Extension Services, Southern Leyte State University, Southern Leyte, Sogod, Philippines
Faculty of Management and Development Studies, University of the Philippines (Open University), Laguna, Los Baños, Philippines
Department of Internal Medicine, Shifa International Hospital, Islamabad, Pakistan
Department of Neurosurgery, Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Osun State, Ife, Nigeria
Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY, United States
Mohammed VI Higher Institute of Biosciences and Biotechnologies, Mohammed VI University of Sciences and Health, Casablanca, Morocco
Interdisciplinary Laboratory of Biosciences and Health, Neurosciences and Cellular Physiology Unit, Mohammed VI Center for Research and Innovation, Rabat, Morocco
Department of Neurosurgery, St. George’s University Hospital, London, United Kingdom
School of Nursing and Health Sciences, Biliran Province State University, Biliran, Naval, Philippines
School of Teacher Education, Biliran Province State University, Biliran, Naval, Philippines
Dow Medical College, Karachi, Pakistan
Shaheed Mohtarma Benazir Bhutto Medical College, Lyari Hospital Rd, Rangiwara Karachi, Karachi, 75010, Pakistan
Global Surgery Fellow, Operation Smile Inc., Virginia Beach, VA, United States
Association of Future African Neurosurgeons, Karu, Nigeria
Faculty of Medicine, Mutah University, Al-Karak, Jordan
Mackenzie Evangelical College of Paraná, Curitiba, Brazil
Department of Surgery, Ayub Medical College, Abbottabad, Pakistan
College of Medicine, University of the East Ramon Magsaysay Memorial Medical Center, Manilla, Philippines
Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal

Department of Research
University College London Medical School
Department of Neurosurgery
Department of Vascular Neurosurgery
Pontifical Catholic University of Paraná
Department of Global Health and Development
Office for Research
Faculty of Management and Development Studies
Department of Internal Medicine
Department of Neurosurgery
Department of Neurosurgery
Mohammed VI Higher Institute of Biosciences and Biotechnologies
Interdisciplinary Laboratory of Biosciences and Health
Department of Neurosurgery
School of Nursing and Health Sciences
School of Teacher Education
Dow Medical College
Shaheed Mohtarma Benazir Bhutto Medical College
Global Surgery Fellow
Association of Future African Neurosurgeons
Faculty of Medicine
Mackenzie Evangelical College of Paraná
Department of Surgery
College of Medicine
Department of Neurosurgery

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