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

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>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).</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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&lt; 0.0001). The mean interference with global function scores were 6.2 preoperatively and reduced to 1.0 at last follow-up (p &lt; 0.0001). The mean interference with facial function was 7.3 preoperatively and reduced to 1.2 at last follow-up (p &lt; 0.0001). The mean follow-up period after surgery was 15 ± 8 months.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p></jats:sec>

Endoscopic and Microscopic Microvascular Decompression

“…The authors recently published their early experience with fully e-MVD for trigeminal neuralgia with promising results. 9 In this series of 47 consecutive patients undergoing E-MVD, there was again no morbidity attributable to using the endoscope, and patient outcomes were promising with 94% of patients endorsing improvement of preoperative symptoms. The authors are currently preparing a manuscript comparing results between E-MVD and conventional MVD, and identification of vessels is more successful with the use of the endoscope; however, early results demonstrate equivalent pain-free results.…”

“…[5][6][7][8] More recently, endoscopic approaches have been developed for use in lateral skull-base surgery, and in particular, in the surgical treatment of trigeminal neuralgia. [9][10][11] In this article, the fully endoscopic microvascular decompression (E-MVD) for patients with trigeminal neuralgia is discussed.…”

Microvascular Decompression for Trigeminal Neuralgia: Our Experiences at Bir Hospital

“…Recurrence is about 20-30% in most of the published series of MVD. 1,2,13,14 In Barker and Jannetta's series of 1185 cases recurrence rate was 30% in 20 years followed up period and most of the recurrence occurred within fi rst two years after surgery. 1 Burchiel et al reported 6% recurrence at 60 months and 42% in 100 months.…”

The Role of Imaging for Trigeminal Neuralgia

“…Importantly, visualization of neurovascular conflict may be difficult intraoperatively, particularly in the setting of distal compression near the porus trigeminus, when a prominent bony ridge along the posterior wall of the petrous temporal bone obscures visualization of CN V, or when the offending vessel is small and located medial and parallel to the nerve. [18][19][20] Preoperative imaging in those cases may help in surgical planning, for instance, by suggesting the use of an endoscope as an adjunct to the standard operating microscope. 18,19 Recently, DTI has been used to better understand microstructural tissue changes of the trigeminal root in patients with unilateral TGN.…”