OBJECTIVEMicrovascular decompression (MVD) is commonly used in the treatment of trigeminal neuralgia (TN) with positive clinical outcomes. Fully endoscopic MVD (E-MVD) has been proposed as an effective minimally invasive alternative, but a comparative review of the two approaches has not been conducted. The authors performed a meta-analysis of studies, comparing patient outcome rates and complications for the open versus the endoscopic technique.METHODSThe PubMed/MEDLINE and Ovid databases were searched for studies published from database inception to 2017. The search terms used included, but were not limited to, “open microvascular decompression,” “microvascular decompression for trigeminal neuralgia,” and “endoscopic decompression for trigeminal neuralgia.” Criteria for inclusion of studies in the meta-analysis were established as follows: adult patients, clinical studies with ≥ 10 patients (excluding case studies to obtain a higher volume of outcome rates), utilization of open MVD or E-MVD to treat TN, craniotomy and retrosigmoid incision, English-language studies, and articles that listed pain relief outcomes (complete, very good, partial, or absent), recurrence rate (number of patients), and complications (paresis, hearing loss, CSF leakage, cerebellar damage, infection, death). Relevant references from the chosen articles were also included.RESULTSFrom a larger pool of 1039 studies, 23 articles were selected for review: 13 on traditional MVD and 10 on E-MVD. The total number of patients was 6749, of which 5783 patients (and 5802 procedures) had undergone MVD and 993 patients (and procedures) had undergone E-MVD. Analyzed data included postoperative pain relief outcome (complete or good pain relief vs partial or no pain relief), and rates of recurrence and complications including facial paralysis, weakness, or paresis; hearing loss; auditory and facial nerve damage; cerebrospinal fluid leakage; infection; cerebellar damage; and death.Good pain relief was achieved in 81% of MVD patients and 88% of E-MVD patients, with a mean recurrence rate of 14% and 9%, respectively. Average rates of reported complications were statistically lower in E-MVD than in MVD approaches, including facial paresis or weakness, hearing loss, cerebellar damage, infection, and death, whereas cerebrospinal fluid leakage was similar. The overall incidence of complications was 19% for MVD and 8% for E-MVD.CONCLUSIONSThe reviewed literature revealed similar clinical outcomes with respect to pain relief for MVD and E-MVD. The recurrence rate was lower in E-MVD studies, though not significantly so, and the incidence of complications, notably facial paresis and hearing loss, were statistically higher for MVD than for E-MVD. Based on these results, the use of endoscopy to perform MVD for TN appears to offer at least as good a surgical outcome as the more commonly used open MVD, with the possible added advantages of having a shorter operative time, smaller craniotomy, and lower recurrence rates. The authors advise caution in interpreting these data given the asymmetry in the sample size between the two groups and the relative novelty of the E-MVD approach.

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Background:Suprasellar cavernous malformation in the optic pathway is not commonly encountered. To date, there are only few reports present in the literature.Case Description:The authors report a rare case of suprasellar optic pathway cavernous malformation in a 33-year-old female who presented with progressive visual loss. Her imaging revealed a large heterogeneous, hyperintense, hemorrhagic right suprasellar extra-axial complex cystic structure, causing mass effect on the adjacent hypothalamus and third ventricle displacing these structures. Gross total resection of the lesion was achieved utilizing a right frontal craniotomy approach. Histopathological examination confirmed the diagnosis of suprasellar chiasmal cavernous malformation.Conclusion:Although visual pathway cavernous malformation is a rare event, it should be included in the differential diagnosis of lesions occurring suprasellarly in the visual pathway and hypothalamus.

Background: Microvascular decompression (MVD) is commonly used in the treatment of trigeminal neuralgia with positive clinical outcomes. Fully endoscopic microvascular decompression (E-MVD) has been proposed as a minimally invasive, effective alternative, but a comparative review of the two approaches in the literature has not been conducted. Methods: We performed a meta-analysis comparing patient outcome rates and complications for both techniques. From a pool of 1,039 studies, 22 articles were selected for review: 12 open MVD and 10 E-MVD. The total number of patients was 6,734. Results: Good pain relief was achieved in 81% of MVD and 88% of E-MVD patients, with a mean recurrence rate of 14% and 9% respectively. Average rates of complications in MVD versus E-MVD included facial paresis or weakness, 9%, 3%; -hearing loss, 4%, 1%; cerebrospinal leak, both 3%; cerebellar damage and infection, 2%, <1%; and mortality <1%, 0% respectively. Conclusions: The reviewed literature revealed similar clinical outcomes with respect to pain relief for both approaches. Recurrence rate and incidence of complications, notably facial paresis and hearing loss were higher for MVD. We concluded that E-MVD appears to offer at least as good a surgical outcome as MVD, with possibly a shorter operative time, smaller craniectomy and lower recurrence rates.

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