Endoscopic Vascular Decompression versus Microvascular Decompression of the Trigeminal Nerve

Abstract

Microvascular decompression (MVD) is a highly accepted and effective method for treatment of patients with trigeminal neuralgia in whom compression of the nerve by a vascular structure is implicated in the pathogenesis of the disease. However, recent reports have highlighted the advantages of the endoscope in visualizing structures within the cerebellopontine angle. Additional research, using the endoscope to supplement the microscopic procedure, has demonstrated improved localization of neurovascular conflicts. In this report we present the results of our series utilizing a fully endoscopic vascular decompression (EVD) technique, and compare these results to those published for microvascular decompression. From September 1999 until October 2004, 255 patients underwent endoscopic vascular decompression of the trigeminal nerve. These patients' records were retrospectively reviewed, and additional data from follow-up visits were collected and analyzed to ascertain success rates and review the incidence of complications. From a total of 255 patients who underwent EVD of the trigeminal nerve we noted an initial, complete, postoperative success rate in 95 % of patients. Initial, being defined as within the first 3 months postoperative, and "complete" being judged if the patient reported 98 % relief of pain postoperatively without the need for medication (Barker's classification). Additionally, we documented a 93 % complete success rate for 118 patients who completed at least a three-year follow-up period. Complication rates were compared to those reported for MVD. There were no serious complications or mortality in this series. We conclude that EVD is a safe and effective method to remove neurovascular conflicts related to the trigeminal nerve. The results of this series demonstrate an improved rate of trigeminal neuralgia relief with EVD when compared to MVD, a lower incidence of complications and a better outcome.

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

“…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.…”

Minimally Invasive Endoscopic and Endoscopy-Assisted Microsurgery of Vestibular Schwannoma

“…Although its use has been described as an adjunctive imaging modality in many surgical procedures the use of endoscopy as the sole means of intra-operative imaging in this setting has not been reported at that time. Microvascular decompressions were the first fully endoscopic procedures reported (Eby et al 2001, Jarrahy et al 2002a, Jarrahy et al 2002b, Kabil et al 2005, Cheng et al 2008). The first report of fully endoscopic resection of vestibular schwannoma was by Shainian and coworkers in 2004 (Shahinian et al 2004).…”

Infranuchal Infrafloccular Approach to the More Vulnerable Segments of the Facial Nerve in Microvascular Decompressions for the Hemifacial Spasm

“…Therefore, it has been generally accepted that MVD of the compressing vessels from the REZ is an effective treatment option for HFS 3,[12][13][14][15][16][17]19,22,23,26,29,33,39) . The REZ has been regarded as the area in which the sheath of the facial nerve is converted to the peripheral myelin composed of Schwann cells from the central glial myelin 6,13,35) .…”