Fully Endoscopic Microvascular Decompression: Our Early Experience

Halpern, Casey H.; Lang, Shih-Shan; Lee, John Y.K.

doi:10.1155/2013/739432

Cited by 27 publications

(36 citation statements)

References 13 publications

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“…This transition from MVD to E-MVD has been detailed in a prior paper from our group. 7 In the last full year, from August 2012 to July 2013 (representing 35 cases), microscopic MVD was only performed in 1 case because the endoscope-holding arm was not physically available. This absence was identified prior to the start of surgery.…”

Section: Resultsmentioning

confidence: 99%

“…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%

“…has thus developed a technique for safe, efficient, and fully endoscopic microvascular decompression (E-MVD) of the trigeminal nerve. 7,13 We present the results for the first 47 consecutive patients treated with E-MVD of the trigeminal nerve for trigeminal neuralgia (TN). We review our surgical technique as well as short-term results including surgical complications and medium-term outcomes in facial pain measured with a validated facial pain instrument.…”

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confidence: 99%

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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: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

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confidence: 99%

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

Bohman

Pierce²,

Stephen³

et al. 2014

FOC

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“…In this way, a new procedure or new treatment for patients with refractory facial pain can be validated and hopefully approved. 17,23 Fortunately, patients with TN have had great success with microvascular decompression, Gamma Knife treatment, and glycerol rhizotomy; however, patients with atypical facial pain continue to suffer from a lack of validated treatment options.…”

Section: Future Directionsmentioning

confidence: 99%

Brief Pain Inventory–Facial minimum clinically important difference

Sandhu¹,

Halpern²,

Vakhshori³

et al. 2015

JNS

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OBJECT Neurosurgeons are frequently the primary physicians measuring pain relief in patients with trigeminal neuralgia (TN). Unfortunately, the measurement of pain can be complex. The Brief Pain Inventory–Facial (BPI-Facial) is a reliable and validated multidimensional tool that consists of 18 questions. It measures 3 domains of pain: 1) pain intensity (worst and average pain intensity), 2) interference with general activities of daily living (ADL), and 3) face-specific pain interference. The objective of this paper is to determine the patient-reported minimum clinically important difference (MCID) using the BPI-Facial. METHODS The authors conducted a retrospective study of 234 patients with TN seen in a single neurosurgeon's office. Patients completed baseline and 1-month follow-up BPI-Facial questionnaires. The MCID was calculated using an anchor-based approach in which the defined anchor was the 7-point patient global impression of change (PGIC). Two statistical methods were employed: mean change score and optimal cutoff point. RESULTS Using the mean change score method, the investigators calculated the MCID for the 3 domains of the BPIFacial: 44% and 30% improvement in pain intensity at its worst and average, respectively, 54% improvement in interference with general ADL, and 63% improvement in interference with facial ADL. Using the optimal cutoff point method, they also calculated the MCID for the 3 domains of the BPI-Facial: 57% and 28% improvement in pain intensity at its worst and average, respectively, 75% improvement in interference with general ADL, and 62% improvement in interference with facial ADL. CONCLUSIONS The BPI-Facial is a multidimensional pain scale that measures 3 domains of pain. Although 2 statistical methods were used to calculate the MCID, the optimal cutoff point method was the superior one because it used data from the majority of subjects included in this study. A 57% improvement in pain intensity at its worst and a 28% improvement in pain intensity at its average were the MCIDs for patients with facial pain. A greater improvement was needed to achieve the MCID for interference with general and facial ADL. A 75% improvement in interference with general ADL and a 62% improvement in interference with facial ADL were needed to achieve an MCID. While pain intensity is easier to measure, pain's interference with ADL may be more important for patient outcomes when designing or evaluating interventions in the field of TN. The BPI-Facial is a useful instrument to measure changes in multidimensional aspects of pain in patients with TN.

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“…[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.…”

Section: Introductionmentioning

confidence: 99%