Endoscope Assisted Microvascular Decompression: Are the Advantages Still Worthy Towards More?

Abstract

Background Microvascular decompression is the definitive treatment of various neuralgias affecting cranial nerves. The compression on a cranial nerve could be at the root entry zone, especially the trigeminal nerve. Endoscope-assisted microsurgery may help avoid missing a hidden vascular structure. Study design Retrospective clinical case series. Patient and methods Twenty-five patients with facial pain and five patients with hemifacial spasm constituted this study. FIESTA MRI was the pre-operative neuroimaging modality. Retrosegmoid craniectomy was done for all patients. Microscope was initially used for exploration and arachnoid dissection around the nerve. The endoscope was applied thereafter for exploration and confirmation of the proper insertion of the Teflon. Results Using the endoscope, cerebellar retraction was reduced by 0.5 to 0.8 cm in 90% of patients. Root entry zone and entry of the nerve through the corresponding skull base foramen was clearly visualized by the endoscope. Endoscope enabled a wider area of exploration and panoramic view, which could not be obtained by the microscope. Patients with trigeminal neuralgia had a median pre-operative VAS of 9, while it was only 1 in early post-operative and 0 in 6-month post-operatively. Patients with HFS were completely recovered. Conclusion The advantages of microvascular decompression are still worthy. Complications are minimal, and the view is much more panoramic. The different viewing angles and ability to directly reach corners is an absolute endoscopic advantage. Therefore, avoidance of missing vascular structures and incomplete recovery can be assured.

Evaluation of Endoscopic Microvascular Decompression for Trigeminal Neuralgia

“…All domains of general function and facial function scores were significantly improved immediately postoperative and progressive improvement was witnessed until the end of follow up duration. [18] reported a female sex predominance [76.0%] among 25 patients with TN, and SCA was the commonest compressed vessel [88%]. Yadav et al [19] found 28/51 patients [54.9%] were V2 and 20/51 were V3 [39.2%].…”

Simultaneous Surgical Treatment of Vestibular Schwannoma and Hemifacial Spasm via Minimally Invasive Retrosigmoid Approach

“…Thus, an endoscopically assisted minimally invasive retrosigmoid approach was the ideal option for treating both pathologies for experienced surgeon. 11) Compression of the facial nerve at the REZ by the vessel responsible for HFS can be assessed by MRI, which also allows detection of a cerebellopontine angle tumor. 12) This information is important for surgical decision-making.…”