脳神経減圧術の歴史—三叉神経痛，顔面痙攣に対する手術療法の発展

Developmental History of Microvascular Decompression Surgery for Cranial Nerve Dysfunction

Point

・三叉神経痛や顔面痙攣に対する手術療法の発展には長い歴史があり，その初期の頃は脳神経の部分切除術で，術後の合併症が問題であった．

・1960年頃，米国でその発症原因が動脈による脳神経圧迫であることが解明され，脳神経を動脈の圧迫から解放する脳神経減圧術が広く発展してきた．

・わが国でも1980年頃から脳神経減圧術が行われるようになり，1998年に第1回日本脳神経減圧術学会が開催された．2023年で第25回を迎えたが，この治療法はさらに広く認識され発展してきた．

　Trigeminal neuralgia is characterized by severe lancinating pain in the face and hemifacial spasms displayed by continuous facial muscle twitching, which may impair a patient's quality of life. Before 1960, in the United States of America, the treatment of such symptoms was only partial rhizotomy of the cranial nerves, which resulted in postoperative complications.^{1, 2）} Afterwards, in the late 1960s, it became evident that the etiology of symptoms was an elicited arterial compression of the cranial nerves at the “Root Entry/Exit zone.” Microvascular decompression（MVD）was introduced and finally became largely popularized by Gardner and Jannetta et al.^{3, 4）} In 1978, at the Neurosurgical Meeting in New York, I incidentally witnessed slides of MVD proposed by Jannetta, which gave me a big surprise since we were then treating such patients by old-fashioned rhizotomy. Despite much ignorance displayed even in the neurosurgical meeting, I started MVD in 1980.^5） In addition, in 1998 we held an Annual Meeting of the Japan Society for Microvascular Decompression Surgery, which has become more active in the fields of microsurgical techniques, diagnosis, monitoring, and long-term follow-up studies.^6-8） MVD is a functional neurosurgery and satisfactory results should entail a complete and permanent cure of symptoms without any postoperative sequelae. This makes MVD a sustainable surgery.