[Endovascular treatment of spinal dorsal intradural arteriovenous fistulas]. / Tratamiento endovascular de las fístulas arteriovenosas intradurales dorsales espinales.

BACKGROUND: The dorsal spinal intradural arteriovenous fistulas (DSIAF) are infrequent and complex injuries are underdiagnosed condition and disability. The aim is to present our experience in the endovascular management. METHODS: A retrospective and prospective study of patients with DSIAF treated by endovascular therapy (EVT) with n-butyl-cyanoacrylate during the period 2007-2013. RESULTS: 15 patients, 12 men and 3 women, mean age 37 years, were included. In 12 cases, the presentation was progressive and insidious over a period between 6 months and one year, while 3 had bleeding. The lesion in the thoracic location had 73 % of cases, lumbar 20 % and cervical 7 %. Prior to treatment observed disability grades 5 and 4 in 73 %, and 67 % had micturition disturbances. Complications grade 3, only one patient had transient deterioration of alert 6 hours after the procedure. Improvement to grades 1 and 2 disability at 48 hours, 3 and 6 months, 53 %, 73 % and 87 % respectively was found. CONCLUSION: EVT has a short operating time, bleeding volume is very low and the hospital stay is short compared with other surgical techniques. EVT is a safe and significant effectiveness in treating DSIAF procedure. This is the first series of cases treated with EVT in Mexico.

Introducción: las fístulas arteriovenosas intradurales dorsales espinales (FAVIDE) son lesiones poco frecuentes y complejas que son subdiagnósticadas y condicionan discapacidad. El objetivo es presentar nuestra experiencia en el manejo endovascular. Métodos: estudio ambispectivo de pacientes con FAVIDE, tratados mediante terapia endovascular (TEV) con n-butil-cianoacrilato en el periodo de 2007 a 2013. Resultados: se incluyeron 15 pacientes con edad media de 37 años. En 12 casos la presentación fue progresiva e insidiosa en un lapso de entre 6 meses y un año, mientras que 3 presentaron hemorragia. La lesión tuvo localización torácica en 73 % de los casos, lumbar en 20 % y cervical en 7 %. Previo al tratamiento observamos discapacidad de grados 5 y 4 en 73 %, y 67 % tenían alteraciones de la micción de grado 3. Como complicaciones, solo una paciente tuvo deterioro del estado de alerta transitorio 6 horas después del procedimiento. Se encontró una mejoría hacia los grados 1 y 2 de discapacidad, a las 48 horas, 3 y 6 meses, de 53 %, 73 % y 87 %, respectivamente. Conclusiones: con la TEV se tiene un tiempo quirúrgico corto, el volumen de hemorragia es bajo y la estancia hospitalaria es corta, respecto de otras técnicas quirúrgicas. La TEV es un procedimiento seguro y con efectividad significativa en el tratamiento de FAVIDE. Esta es la primera serie de casos tratados con TEV en México.

[Invasive management of trigeminal neuralgia. 8 years experience]. / Manejo invasivo de la neuralgia del trigémino. Experiencia de 8 años.

BACKGROUND: Trigeminal neuralgia (TN) is characterized by stereotyped repetitive, unilateral pain, referred as an electric shock, triggered by the stimulation of the rami of the trigeminy nerve. It presents more frequently in women. The aim is to know the efficacy of surgical treatment of TN against pain by means of microvascular decompressive technics (MDT) and balloon percutaneous microcompression (BPM). METHODS: A retrospective study was performed from January 2005 to January 2013, including 73 patients treated for TN. Sixty patients from group 1 (82 %) were treated with MDT, and 13 from group 2 with BPM. We evaluated the presence of pain in patients during the immediate postoperative period, and at 1, 3 and 5 years. RESULTS: 55 female patients and 18 male patients were included. The mean age of presentation for TN was 55 years. In group 1 there was pain remission in the immediate postoperative period in 95% of the cases, in 92% at one year, 91% at 3 years and 88% at 5 years; in group 2 in 85%, 84%, 84% and 70%, respectively. There were no lethal complications in 6.5% in group 1 and in 28% in group 2. CONCLUSIONS: The two therapeutic procedures reduced pain of TN in a long term in most patients. Our results show high and perdurable resolution of the pain with negligible morbimortality.

Introducción: la neuralgia del trigémino (NT) se caracteriza por un dolor estereotipado, repetitivo, unilateral referido como eléctrico, desencadenado por la estimulación de  ramas del nervio trigémino. Se presenta con mayor frecuencia en mujeres, 2:1 con respecto a sexo masculino. El objetivo fue conocer la eficacia del tratamiento quirúrgico de NT contra el dolor mediante las técnicas de descompresión microvascular (DMV) y microcompresión percutánea con balón (MPB). Métodos: estudio retrospectivo, en el periodo entre enero de 2005 y enero de 2013, de 73 pacientes tratados por NT. Los 60 pacientes del grupo 1 fueron tratados con DMV, y los 13 del grupo 2 con MPB. Se evaluó la presencia de dolor de los pacientes en el postoperatorio inmediato y a 1, 3 y 5 años. Resultados: se incluyeron 55 pacientes del sexo femenino y 18 hombres. La edad media de presentación de NT fue a los 55 años de edad. En el grupo 1 hubo remisión del dolor en el postoperatorio inmediato en 95 % de los casos, en 92 % al primer año, 91 % a los 3 años y 88 % a los 5 años y en el grupo 2: 85 %, 84 %, 84% y 70 % respectivamente. Conclusiones: los dos procedimientos terapéuticos redujeron el dolor de NT a largo plazo en la mayoría de los pacientes. Nuestros resultados muestran resolución alta y perdurable del dolor con escasa morbimortalidad.

[Endoscopic third ventriculostomy for chronic communicating hydrocephalus in adults]. / Tercer ventriculostomía endoscópica secundaria en hidrocefalia comunicante crónica en el adulto.

BACKGROUND: Shunt devices to treat hydrocephalus are associated with a malfunction of 81 % at 12 years and 10 % of infection. The objective was to assess safeness and efficacy of endoscopic third ventriculostomy (ETV) for the treatment of chronic communicating hydrocephalus. METHODS: Eight patients with chronic communicating hydrocephalus were included in a period between September, 2012 and April, 2013. X ray computed tomography scans were performed when patients were admitted, after the surgery, and at 30, 180 and 365 days. The follow-up was of 251 days (the biggest was of 459 days). The variables included were: age, sex, etiology, time of evolution, and the total number of shunt malfunctions. Conventional technique with a 30° rigid endoscope was performed, malfunctional shunt was removed, and a tied shunt device was placed. RESULTS: Four males and four females, with a mean age of 42 years (27-63 years); neurocysticercosis was identified in five patients (62.5 %); the evolution rate was of 18 years (15-30 years); the hospital stay rate was of 6.5 days (3-22 days); the mean of previous shunt malfunctions was 4 (1-6). COMPLICATIONS: neuroinfection in one patient, malfunction in three patients. None of them died. CONCLUSIONS: ETV is a safety procedure for treating chronic communicating hydrocephalus; it has a success rate higher than 60 %. Neurocysticercosis showed better results when previous shunt malfunctions were lower than three.

Introducción: la derivación valvular para tratar la hidrocefalia se asocia con disfunción del 81 % a 12 años y 10 % de infección. El objetivo es evaluar la seguridad y la eficacia clínica de la tercer ventriculostomía endoscópica secundaria (TVE) en pacientes con hidrocefalia comunicante crónica. Métodos: se incluyeron ocho pacientes adultos entre septiembre de 2012 y abril de 2013 con hidrocefalia por disfunción valvular de etiología comunicante. Se les hizo estudio de tomografía axial computarizada al ingreso, postoperatoria, y después de 30, 180 y 365 días. El seguimiento clínico fue de 251 días (el mayor fue de 459 días). Las variables incluidas fueron: edad, sexo, etiología, tiempo de evolución y número de sistemas valvulares fallidos. Se aplicó técnica convencional con endoscopio rígido 30°, retiro de catéter disfuncional, y colocación de sistema valvular ligado. Resultados: cuatro hombres y cuatro mujeres, con edad promedio de 42 años (27-63 años), neurocisticercosis en cinco pacientes (62.5 %), evolución promedio de 18 años (15-30 años), estancia hospitalaria promedio 6.5 días (3-22días), disfunciones valvulares previas promedio 4 (1-6). Complicaciones: hubo neuroinfección en un paciente y disfunción en tres pacientes. Ninguno murió. Conclusión: la TVE secundaria es un procedimiento seguro en el tratamiento de hidrocefalia comunicante crónica, con una eficacia mayor al 60 %. En neurocisticercosis se observaron mejores resultados con antecedente de dos o menos recambios valvulares.

[Treatment of endovascular aneurysms associated with fenestration of the basilar artery. A case report]. / Tratamiento endovascular de aneurisma asociado a fenestración de la arteria basilar. Reporte de un caso.

The fenestration of the basilar artery is an uncommon anatomical variant that may be associated with saccular aneurysms; however this association is rare. We report the case of a patient who presented with subarachnoid hemorrhage that was successfully treated by coil embolization and review the literature.

[Prognostic factors in elderly patient meningioma]. / Factores pronósticos del meningioma del paciente geriátrico.

BACKGROUND: Frequently, therapeutic decisions must be made in order to manage meningioma in geriatric patients. This study analyzes the prognostic factors, as well as the Clinical Radiological Grading Score (CRGS) as a complement to make therapeutic decisions. METHODS: A retrospective study was conducted between 2009 and 2010. The study population consisted of 28 patients over 65 years of age. We analyzed clinical, imaging and histopathological factors. We used the chi-squared test and the Fisher exact test for quantitative variables, as well as the Mann-Whitney U for qualitative variables. RESULTS: Overall mortality at 3, 6 and 12 months of follow-up was 7.14, 10.71 and 14.28 %, respectively. The analysis revealed that performance status with Karnofsky scale (p = 0.02), the location of the lesion (p = 0.002), histopathological malignancy grade (p = 0.038), and a score lower than 10 on the CRGS (p = 0.003) were associated with poor prognosis. CONCLUSIONS: The neurosurgical management of geriatric patients is a therapeutic option with a favorable prognosis in patients with a score equal to or greater than 10 and those with adequate functional status.

Introducción: frecuentemente debe tomarse una decisión terapéutica para el manejo del meningioma en el paciente geriátrico. El presente estudio analiza factores pronósticos, así como la escala Clinical- Radiological Grading Score (CRGS) como auxiliar para la decisión terapéutica. Métodos: se realizó un estudio retrospectivo entre 2009 y 2010. La población estudiada fue de 28 pacientes mayores de 65 años de edad. Se analizaron factores clínicos, imagenológicos e histopatológicos. Se utilizó la prueba chi cuadrada y la exacta de Fisher para variables cuantitativas y U de Mann-Whitney para variables cualitativas. Resultados: la mortalidad global a los 3, 6 y 12 meses de seguimiento fue del 7.14, 10.71 y 14.28 %, respectivamente. El análisis reveló que el estado funcional con la escala de Karnofsky (p = 0.02), la localización de la lesión (p = 0.002), el grado de malignidad histopatológico (p = 0.038) y una puntuación menor de 10 en la escala CRGS (p = 0.003) se asocian con un mal pronóstico. Conclusión: el manejo neuroquirúrgico del paciente geriátrico es una posibilidad terapéutica con un pronóstico favorable en pacientes con una puntuación igual o mayor de 10 y en aquellos con un adecuado estado funcional.

[Endovascular management of residual intracranial aneurysms after surgical clipping]. / Manejo endovascular de aneurismas intracraneales (AI) residuales posquirúrgicos.

OBJECTIVES: To identify and evaluate the cerebral aneurysm remnants after clipping and the endovascular treatment in our institution. METHODS AND MATERIALS: We made a clinical ambispective collection of all aneurysms microsurgically clipped during four years and we analyzed their endovascular treatment. RESULTS: There were 290 cerebral aneurysms; in 270 a digital subtraction angiography was made. Ten aneurysm remnants were found (3.7%); of these, a second operation was performed on two, and coil placement was done in six patients. CONCLUSION: The cerebral aneurysm remnants after clipping in our institution are equivalent to international results. The endovascular treatment of this aneurysm is safe and effective.

[Trigeminal-cavernous fistula. Report of a case and review of the literature]. / Fístula trigeminocavernosa. Reporte de un caso y revisión de la literatura.

Persistent primitive trigeminal artery is a rare anatomical variant resulting from the absence of obliteration of the embryonic trigeminal artery. The shunt between the persistent primitive trigeminal artery and the cavernous sinus is called trigeminal-cavernous fistula. We report the case of a woman with a trigeminal-cavernous fistula secondary to head trauma who was treated by transarterial embolization.

[Device for percutaneous insertion of a distal catheter in ventriculo-atrial shunt. Technical report]. / Dispositivo para inserción percutánea del catéter distal en la derivación ventriculoatrial. Reporte técnico.

INTRODUCTION AND OBJECTIVES: A ventriculo-atrial shunt is indicated for the treatment of some hydrocephalus cases. The distal catheter is usually inserted into the right atrium through cervical venous dissection. Percutaneous insertion has been described with success; however its use is not widespread. The aim of this work is to describe modifications in the distal catheter of a ventriculo-atrial shunt, the technique for its percutaneous insertion and the clinical outcome of the process. MATERIAL AND METHODS: The distal catheter was modified after its use in 4 animal specimens. It was designed «over the wire¼, with its flexibility being reduced and accessories being added. The device was subsequently used in humans, with slight modifications of the jugular vein catheterization technique. We evaluated complications, surgical time and outcome during 6months. RESULTS: In the course of one year, 6adult patients in whom the peritoneum was no longer receiving cerebrospinal fluid were treated for hydrocephalus. The mean operating time was 34minutes (including proximal catheter insertion). There were no complications and ventricular size improved. CONCLUSIONS: The percutaneous technique has proved useful: it reduces surgical time and has a very low rate of complications. Apparently, modifications made in the distal catheter caused no complications and avoided the use of other materials designed for other purposes. More cases are required to perform a definitive analysis.

[Endovascular treatment of non-galenic pial arteriovenous fistulas]. / Tratamiento endovascular de las fístulas arteriovenosas piales no galénicas.

INTRODUCTION AND OBJECTIVES: Pial arteriovenous fistulas are infrequent vascular malformations. They are generally congenital and their natural history is ominous. The objective of this work is to describe our experience in their endovascular management and to review the existing literature. PATIENTS AND METHODS: This is a retrospective and descriptive study of patients treated by endovascular approach during 3 years at 3 Latin-American hospitals. RESULTS: The study included 6 patients with a mean age of 22 years. One case was caused by cranial trauma. In total, 50% suffered intracranial haemorrhage and 66% developed symptoms attributable to volume effect or retrograde blood flow. Intracranial varices were identified by CT and MRI scans in 83% of cases. Digital subtraction angiography showed arteriovenous fistulas from anterior circulation in 67% of cases and deep venous drainage in 50%. One endovascular procedure was performed in 5 cases (83%), while 2 procedures were required in one case. A single embolic agent was used to occlude fistulas in 67% of cases; whilst 33% required a combination. Coils were used in 4 cases (67%) and onyx was injected in another 4 (67%). One case required stent and balloon deployment. The fistulas were uneventfully occluded in all cases. The follow-up period was one year in 5 cases and 6 months in one case. All patients remained symptom-free. CONCLUSIONS: Endovascular management can be considered as the treatment of choice. It consists in the embolisation of arterial pedicles with one or more embolic agents and should be performed as close as possible to the drainage vein, avoiding migration of the embolic agent towards the venous side.

Tumor epidermoide del cuarto ventriculo: reporte de un caso y revisión de la literatura / Epidermoid cell tumor of the fourth ventricle: case report and literature review

Los tumores epidermoides representan alrededor del 1 por ciento de todos los tumores intracraneales sindo el ángulo pontocerebeloso el sitio más frecuente de localización. La lesiones del IVto ventrículo son raras. Presentamos el caso de una paciente de 22 años que desarolló hidrocefalia condicionada por un tumor epidermoide del IVto ventrículo.

Epidermoid tumors account for 1 percent of intracranial neoplasms. They are usually found at the cerebello-pontine angle and location in the fourth ventricle is rare. We report the case of a 22-year-old woman with an epidermoid tumor of the fourth ventricle revealed by hydrocephalus.

[Chronic nasal obstruction: ethmoidal encephalocele in an adult patient]. / Obstrucción nasal crónica: encefalocele nasoetmoidal en paciente adulto.

Nasal obstruction is a frequent cause of referral to the ear, nose and throat specialist. When this symptom is resistant to medical management and common causes have been ruled out, the presence of neural structures should be investigated In the nasoethmoidal meningoencephalocele, a congenital defect of the ethmoid lamina cribrosa allows the herniation of the intracranial contents into the nasal fossa. The key to clinical diagnosis is the presence of nasal obstruction with rhinorrhea and recurrent meningitis. We describe the case of a 33-year old female who was long treated for nasal polyposis and underwent a successful surgical treatment of ethmoidal meningoencephalocele.

[Endoscopic endonasal transsphenoidal approach for growth hormone-producing pituitary adenomas. Preliminary results]. / Abordaje endonasal endoscópico transesfenoida en adenomas hipofisiarios productores de hormona de crecimiento. Resultados preliminares.

BACKGROUND: An endoscopic endonasal transsphenoidal approach is reported as less invasive, allowing an earlier discharge. Published series have never focused on its use in acromegalic patients. OBJECTIVE: To assess the effectiveness of an endoscopic endonasal transsphenoidal approach in the management of growth hormone-secreting adenomas. PATIENTS AND METHODS: Nineteen consecutively operated patients were assessed with a prospective follow-up of one year. RESULTS: Sex ratio was 0.7/1 and gross total removal was obtained in 16 cases (84%), subtotal in three (16%). The only complication was a cerebrospinal fluid leak requiring spinal drainage. The median in-hospital stay was 2.5 days. Sixteen patients experienced clinical improvement (84%) and no changes were observed in three (16%). Residual tumor was seen in two cases (11%). Growth hormone levels < 2 ng/dl were seen in 17 cases (89%) and only two patients (11%) had a level >2 ng/dl. Insulin-like growth factor-1 levels were normalized in 16 cases (84%) and remained elevated in three patients (16%). One patient presented an isolated elevated level of insulin-like growth factor-1. Patients with residual tumor and elevated growth hormone and insulin-like growth factor-1 levels underwent complementary radiosurgery. CONCLUSIONS: The endoscopic endonasal transsphenoidal approach seems to be useful in acromegaly, with a high rate of clinical and biochemical cure among other benefits.

Genetic similarity between cysticerci of Taenia solium isolated from human brain and from pigs.

Mitochondrial (mt) cox1 and ribosomal ITS1 DNA sequences from Taenia solium cysticercus isolates from pigs and cysticerci (racemose and cellulose types) from patients with neurocysticercosis were amplified by the polymerase chain reaction (PCR). The amplicons were sequenced in order to determine the genetic relationship between these types of cysticerci. Phylogenetic trees were constructed and evolutionary distances were calculated. ITS1 and mt cox1 cysticerci sequence data were compared with previously published Taenia spp. sequences. The variation in the ITS1 and cox1 sequences of samples collected from Mexico was minimal, regardless of geographical origin, size or colour of cysticerci from either pigs or human brain. These results suggest that the racemose and cellulose types represent genetically identical metacestodes of T. solium. Alignment of the mt cox1 sequences of the Mexican samples with sequences of other Taenia taxa showed that most were very similar to T. solium from Mexico and T. solium from Colombia; one T. solium Mexican isolate and Taenia hydatigena were placed in the same group close to Taenia crassiceps. The ITS1 sequences for the Mexican T. solium samples indicated the majority were in the same group as the Latin American T. solium. Two Mexican T. solium samples and T. solium from Philippines were placed together in a different group.

Enfermedad de Lhermitte-Duclos: Informe de un caso y revisión de la literatura / Lhermitte-Duclos disease: Case report and review of literature

Introducción. El gangliocitoma displásico del cerebelo fue descrito originalmente en 1920 por Lhermitte y Duelos, autores a quienes se les debe el epónimo de esta enfermedad. Es una entidad rara, caracterizada por ser una masa tumoral unilateral de la corteza cerebelosa, de crecimiento muy lento, que produce un aumento de la presión intracraneana. En 1991 Padberg y col. describieron la asociación de la enfermedad Lhermitte-Duclos y el síndrome de Cowden (SC). Aún no se ha comprendido completamente la biología molecular que asocia a estas enfermedades, sin embargo se ha comprobado en estudios modelos animales (ratones) mutaciones del gen homólogo de fosfatasa y tensina suprimido del cromosoma 10 (PTEN). Las imágenes de resonancia magnética son características de esta entidad, de tal manera que permiten hacer el diagnóstico preoperatorio sin la necesidad de estudios histopatológicos, permitiendo una evaluación y manejo neuroquirúrgico adecuados. Caso clínico. Se informa el caso de una mujer de 17 años con enfermedad de Lhermitte-Duclos del hemisferio cerebeloso derecho no asociado a SC, en quien el diagnóstico se estableció en el transoperatorio con improntas de la lesión cerebelosa. Conclusión. No existen publicaciones previas que describan las características cito lógicas de la lesión, y en este caso sí fue posible estudiarlas.

Introduction. Dysplastic cerebellar gangliocytoma was first described in 1920 by Lhermitte and Duelos, authors who gave their name to the entity. It is a rare condition, which is characterized by a very slowly growing unilateral tumor mass of the cerebellar cortex, producing increased intracranial pressure. In 1991 Padberg et al. described the association of Lhermitte-Duclos disease and Cowden syndrome. The relationship between these 2 entities has been associated with mutations of the phosphatase and tensin homolog deleted on chromosome (PTEN) gene. Magnetic resonance imaging findings are the hallmark of this entity, and the diagnosis is established without hystopathologic studies. Case report. We inform a case of a 17 years old girl with Lhermitte-Duclos of the right cerebellar hemisphere without Cowden syndrome.

[Surgical treatment for trigeminal neuralgia]. / Tratamiento quirúrgico de la neuralgia del nervio trigémino.

We treated 50 patients at the Hospital de Especialidades, Centro Médico Nacional La Raza, IMSS, in Mexico City, with trigeminal neuralgia by two procedures: a) microvascular decompression of the trigeminal nerve with asterional craniectomy, or b) compression of Gasser's nodule by percutaneous puncture. Each patient was allowed to choose one of the procedures after informed consent. Twenty two patients underwent percutaneous puncture, while 28 patients underwent microvascular decompression. Our study group comprised 35 females and 15 males between the ages of 38 and 80 years. After 3 months, we achieved good-to-excellent results in 25 patients with microvascular decompression and in 15 patients, with compression of Gasser's nodule. At 2 years follow-up, our results remained the same for microvascular decompression group while in the other group we observed only satisfactory results in 59% of cases. In craniectomy group, we found vascular compression in 96% of cases. Five patients presented hypoacusia after decompressive procedure and eight patients had facial dysesthesia after percutaneous procedure. In percutaneous group, procedures were cancelled due to technical difficulties in two cases. We conclude that both procedures are safe, with zero mortality. The microvascular procedure affords better results at 2 years follow-up.

Tratamiento quirúrgico de la neuralgia del nervio trigémino / Surgical Treatment for Trigeminal neuralgia

Se trataron 50 pacientes en el Hospital de Especialidades Centro Médico Nacional La Raza con neuralgia del trigémino, mediante dos procedimientos: a) microdescompresión vascular del trigémino mediante craniectomia asterional y b) compresión del ganglio de Gasser por punción per cutánea. El paciente eligió el procedimiento quirúrgico previa información detallada. A 22 pacientes se les realizó punción y a 28 microdescompresión. Las edades variaron de 38 a 80 años, 35 mujeres y 15 hombres. Los resultados a tres meses fueron buenos o excelentes en 25 pacientes con la microdescompresión y en 15pacientes con la compresión. A dos años los resultados seguían iguales a quienes se les realizó microdescompresión y en los pacientes tratados con compresión los resultados satisfactorios habían disminuido 59% de los casos. Se encontró compresión vascular en 96% de los casos de los pacientes que se realizó craniectomía. Tuvimos cinco pacientes con hipoacusia después de la microdescompresión y ocho con disestesia facial después de la compresión, y en dos casos de compresión el procedimiento no se pudo llevar a cabo por dificultades técnicas. Uno y otro procedimientos son seguros, con nula mortalidad, pero con mejores resultados a dos años con la microdescompresión vascular.

We treated 50 patients at the Hospital de Especialidades, Centro Médico Nacional La Raza, LMSS, in Mexico City, with trigeminal neuralgia by two procedures: a) microvascular decompression of the trigeminal nerve with asterional craniectomy, or b) compression of Gasser's nodule by percutaneous puncture. Each patient was allowed to choose one of the procedures after informed consent. Twenty two patients underwent percutaneous puncture, while 28 patients underwent microvascular decompression. Our study group comprised 35 females and 15 males between the ages of 38 and 80 years. After 3 months, we achieved good-to-excellent results in 25 patients with microvascular decompression and in 15 patients, with compression of Gasser's nodule. At 2 years follow-up, our results remained the same for microvascular decompression group while in the other group we observed only satisfactory results in 59% of cases. In craniectomy group, we found vascular compression in 96% of cases. Five patients presented hypoacusia after decompressive procedure and eight patients had facial dysesthesia after percutaneous procedure. In percutaneous group, procedures were cancelled due to technical difficulties in two cases. We conclude that both procedures are safe, with zero mortality. The microvascular procedure affords better results at 2 years follow-up.