Endoscopic Vascular Decompression for the Treatment of Trigeminal Neuralgia: Clinical Outcomes and Technical Note

Setty, Pradeep; Волков, А.А.; D'Andrea, Kenneth P.; Pieper, Daniel R.

doi:10.1016/j.wneu.2013.10.036

Cited by 32 publications

(19 citation statements)

References 12 publications

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“…2,7,11,21,24 All report excellent safety and short-to medium-term functional results. The largest of these, by Kabil et al, reported results for 255 patients with a favorable 3-year success rate and a lower rate of complications when compared with published series of microscopic MVD.…”

Section: Discussionmentioning

confidence: 98%

Fully endoscopic microvascular decompression for trigeminal neuralgia: technique review and early outcomes

Bohman

Pierce²,

Stephen³

et al. 2014

FOC

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Object Fully endoscopicmicrovascular decompression (E-MVD) of the trigeminal nerve was initially described more than 1 decade ago, but has not yet gained wide acceptance. The authors present the experience of their first 47 consecutive E-MVDs for trigeminal neuralgia (TN). Methods All surgeries were performed by a single surgeon (J.Y.K.L.) at the Pennsylvania Hospital at the University of Pennsylvania. Patients prospectively completed pain scales before and after surgery by using the Brief Pain Inventory–Facial outcomes tool. All patients were called on the telephone, and the same outcome tool was administered without reference to their preoperative pain status. Results Forty-seven patients (17 men) were identified and enrolled. Forty (85%) had Burchiel Type 1 TN. Vascular compression was observed at surgery in 42 patients (89%). No surgery was aborted or converted to microscope. One patient suffered permanent hearing loss, for a permanent neurological morbidity rate of 2%. Overall improvement in pain outcomes was excellent, with a median maximum pain intensity preoperatively of 10 and postoperatively of 0 (p< 0.0001). The mean interference with global function scores were 6.2 preoperatively and reduced to 1.0 at last follow-up (p < 0.0001). The mean interference with facial function was 7.3 preoperatively and reduced to 1.2 at last follow-up (p < 0.0001). The mean follow-up period after surgery was 15 ± 8 months. Conclusions In experienced hands, E-MVD offers superb visualization and illumination and is both safe and effective, at least in the short term. Further longer-term study is needed to compare E-MVD to traditional microscopic MVD.

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Section: Discussionmentioning

confidence: 98%

Fully endoscopic microvascular decompression for trigeminal neuralgia: technique review and early outcomes

Bohman

Pierce²,

Stephen³

et al. 2014

FOC

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“…4 The use of the endoscope for MVD, however, remains a niche technique used by only a few surgeons. 5,13,19,22,41 Indeed, most studies report using a hybrid technique that we refer to as endoscope-assisted MVD, 33,34,44 in which the angled endoscope is used primarily as an adjunct to the microscope in examining local anatomy. The only study directly comparing M-MVD and E-MVD merely reported raw differences.…”

Section: Discussionmentioning

confidence: 99%

“…Previous E-MVD case series have not examined postoperative headaches. 3,19,41,47 Because the present study was not designed to more closely investigate the incidence of postoperative headaches, we did not have information about their intensity, character, or duration. However, it is clear from the existing literature on retrosigmoid approaches that the headache incidence is highest immediately after the surgery and gradually improves over time (Table 5); therefore, it is safe to assume that headaches will gradually resolve over time in both groups.…”

Section: Postoperative Headachesmentioning

confidence: 99%

“…a fully endoscopic procedure. 3,5,13,19,22,41,47 A direct comparison of E-MVD with microscopic MVD (M-MVD) involving validated outcome tools such as the Penn Facial Pain Scale (PFPS, formerly known as Brief Pain Inventory [BPI]-Facial) has not been reported. 9,24,39 This study is the first direct comparison of bimanual microdissection techniques using either an endoscope or a microscope and involving modern pain-outcome assessment tools.…”

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confidence: 99%

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Endoscopic versus microscopic microvascular decompression for trigeminal neuralgia: equivalent pain outcomes with possibly decreased postoperative headache after endoscopic surgery

Lee

Pierce

Sandhu

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Endoscopic surgery has revolutionized surgery of the ventral skull base but has not yet been widely adopted for use in the cerebellopontine angle. Given the relatively normal anatomy of the cerebellopontine angle in patients with trigeminal neuralgia (TN), the authors hypothesized that a fully endoscopic microvascular decompression (E-MVD) might provide pain outcomes equivalent to those of microscopic MVD (M-MVD) but with fewer complications. METHODS The authors conducted a single-institution, single-surgeon retrospective study with patients treated in the period of 2006-2013. Before surgery, all patients completed a questionnaire that included a validated multidimensional pain-outcome tool, the Penn Facial Pain Scale (PFPS, formerly known as Brief Pain Inventory-Facial), an 11-point scale that measures pain intensity, interference with general activities of daily living (ADLs), and facial-specific ADLs. Using a standardized script, independent research assistants conducted follow-up telephone interviews. RESULTS In total, 167 patients were available for follow-ups (66.5% female; 93 patients underwent M-MVD and 74 underwent E-MVD). Preoperative characteristics (i.e., TN classification, PFPS components, and medication use) were similar for the 2 surgical groups except for 2 variables. Patients in the M-MVD group had slightly higher incidence of V3 pain, and the 2 groups differed in the date of surgery and hence in the length of follow-up (2.4 years for the M-MVD group and 1.3 years for the E-MVD group, p < 0.05). There was a trend toward not finding neurovascular conflict at the time of surgery more frequently in the M-MVD than in the E-MVD group (11% vs 7%, p = 0.052). Internal neurolysis was more often performed in the E-MVD group (26% vs 7%, p = 0.001). The 2 groups did not significantly differ in the length of the MVD procedure (approximately 2 hours). Self-reported headaches at 1 month postoperatively were present in 21% of the patients in the M-MVD group versus 7% in the E-MVD group (p = 0.01). Pain outcomes at the most recent followup were equivalent, with patients reporting a 5- to 6-point (70%-80%) improvement in pain intensity, a 5-point (85%) improvement in pain interference with ADLs, and a 6-point (85%) improvement in interference with facial-specific ADLs. Actuarial freedom from pain recurrence was equivalent in the 2 groups, with 80% pain control at 3 years. CONCLUSIONS Both the fully endoscopic MVD and the conventional M-MVD appear to provide patients with equivalent pain outcomes. Complication rates were also similar between the groups, with the exception of the rate of headaches, which was significantly lower in the E-MVD group 1 month postoperatively.

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“…Recent reports have described fully endoscopic MVD, concluding that fully endoscopic MVD is a safe, minimally invasive, and highly effective alternative to conventional MVD. [4][5][6][7][8][9][10][11][12] In addition to secure observation of neurovascular conflicts, another important element in successful MVD is the method of decompression. MVD has mainly been achieved with two different techniques: interposition and transposition.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Microvascular Decompression with Transposition for Trigeminal Neuralgia and Hemifacial Spasm: Technical Note

Komatsu

Imai

Hirayama

et al. 2016

J Neurol Surg A Cent Eur Neurosurg

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Endoscopic microvascular decompression (MVD) offers reliable identification of neurovascular conflicts under superb illumination, and it provides minimally invasive surgery for trigeminal neuralgia and hemifacial spasm. Transposition techniques have been reported as a decompression method to prevent adhesion and granuloma formation around decompression sites, providing better surgical outcomes. The feasibility and effects of transposition under endoscopic MVD were evaluated. Fully endoscopic MVD was performed using 4-mm 0- and 30-degree endoscopes. The endoscope was fixed with a pneumatic holding system, and a bimanual technique using single-shaft instruments was performed. Transposition was performed with Teflon felt string and fibrin glue. Surgical results were evaluated using the scoring system proposed by Kondo et al. The endoscope was introduced via a retrosigmoid keyhole. The 0-degree endoscope was advanced through the lateral aspect of the cerebellar tentorial surface to the trigeminal nerve in cases of trigeminal neuralgia and through the petrosal surface of the cerebellum to the facial nerve in cases of hemifacial spasm. Neurovascular conflicts and perforators from the offending artery were clearly demonstrated under the 30-degree endoscopic view, and transposition of the offending artery was safely performed with preservation of perforators. Clinical symptoms improved without permanent complications. Endoscopic MVD with the transposition technique is feasible. Superb endoscopic views demonstrate perforators arising from the offending artery behind the corner, allowing damage to perforators to be avoided during the transposition technique. Endoscopic MVD using the transposition technique is expected to offer excellent surgical results.

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Endoscopic Vascular Decompression for the Treatment of Trigeminal Neuralgia: Clinical Outcomes and Technical Note

Cited by 32 publications

References 12 publications

Fully endoscopic microvascular decompression for trigeminal neuralgia: technique review and early outcomes

Fully endoscopic microvascular decompression for trigeminal neuralgia: technique review and early outcomes

Endoscopic versus microscopic microvascular decompression for trigeminal neuralgia: equivalent pain outcomes with possibly decreased postoperative headache after endoscopic surgery

Endoscopic Microvascular Decompression with Transposition for Trigeminal Neuralgia and Hemifacial Spasm: Technical Note

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