Endoscope-assisted Microsurgery for Microvascular Compression Syndromes

Rak, Ramin; Sekhar, Laligam N.; Štimac, Dinko; Hechl, Peter S.

doi:10.1227/01.neu.0000115151.52925.37

Cited by 97 publications

(71 citation statements)

References 17 publications

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“…Multiple groups have demonstrate that endoscope-assisted approaches (where the bulk of the procedure is done with the operating microscope but an endoscope is used to inspect the nerve before or after decompression) lead to increasing identification of vascular contact and compression, which were not appreciated with microscopy alone. 1,4,5,8,12,18,20,23 However, using the endoscope in the CPA sacrifices binocular vision and is technically challenging, with its own learning curve.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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

Bohman

Pierce²,

Stephen³

et al. 2014

FOC

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“…39 This is an especially prominent problem with the angled endoscope, which, when advanced forward, does not show what lies straight ahead. 5,9,28 Image fusion technology, carefully designed instrumentation, antifogging, and irrigation devices improve the safety of endoscopes. 32 Most studies of endoscopic surgeries for thalamic lesions are limited to the anterior part of the thalamus 36 or endoscopic biopsy, 1,33 but none have focused on the pulvinar.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical and endoscopic approaches to the pulvinar

Akiyama

Matsushima

Güngör

et al. 2017

Journal of Neurosurgery

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OBJECTIVEApproaches to the pulvinar remain challenging because of the depth of the target, surrounding critical neural structures, and complicated arterial and venous relationships. The purpose of this study was to compare the surgical approaches to different parts of the pulvinar and to examine the efficacy of the endoscope as an adjunct to the operating microscope in this area.METHODSThe pulvinar was examined in 6 formalin-fixed human cadaveric heads through 5 approaches: 4 above and 1 below the tentorium. Each approach was performed using both the surgical microscope and 0° or 45° rigid endoscopes.RESULTSThe pulvinar has a lateral ventricular and a medial cisternal surface that are separated by the fornix and the choroidal fissure, which wrap around the posterior surface of the pulvinar. The medial cisternal part of the pulvinar can be further divided into upper and lower parts. The superior parietal lobule approach is suitable for lesions in the upper ventricular and cisternal parts. Interhemispheric precuneus and posterior transcallosal approaches are suitable for lesions in the part of the pulvinar forming the anterior wall of the atrium and adjacent cisternal part. The posterior interhemispheric transtentorial approach is suitable for lesions in the lower cisternal part and the supracerebellar infratentorial approach is suitable for lesions in the inferior and medial cisternal parts.The microscope provided satisfactory views of the ventricular and cisternal surfaces of the pulvinar and adjacent neural and vascular structures. The endoscope provided multi-angled and wider views of the pulvinar and adjacent structures.CONCLUSIONSA combination of endoscopic and microsurgical techniques allows optimal exposure of the pulvinar.

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“…À l'inverse, l'absence de diagnostic peropératoire formel ou la désignation d'un vaisseau « par défaut » conduisent à de mauvais résultats fonctionnels et des récidives plus fréquentes. On peut alors raisonnablement se poser la question de savoir si les échecs ne seraient pas liés à la méconnaissance d'une compression vasculaire, comme le soutiennent différentes équipes (King et al, 2001 ;Kureshi et Wilkins, 1998 ;Liao et al, 1997 ;Rak et al, 2004). De nombreux conflits ont lieu sur les portions tout à fait proximales ou distales des nerfs : REZ, conduit auditif interne ou cavum de Meckel (Sindou et al, 2002), difficilement accessibles sous microscope.…”

Section: Discussionunclassified

Apport de l’endoscopie pour la décompression microvasculaire dans l’angle ponto-cérébelleux : à propos de 27 cas

et al. 2011

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Endoscope-assisted Microsurgery for Microvascular Compression Syndromes

Abstract: The endoscope is a useful adjunct to MVD in the treatment of trigeminal neuralgia, hemifacial spasm, and disabling positional vertigo or tinnitus.

Cited by 97 publications

References 17 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

Microsurgical and endoscopic approaches to the pulvinar

Apport de l’endoscopie pour la décompression microvasculaire dans l’angle ponto-cérébelleux : à propos de 27 cas

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