Endoscopic and Microscopic Microvascular Decompression

Piazza, Matthew; Lee, John Y.K.

doi:10.1016/j.nec.2016.02.008

Cited by 29 publications

(11 citation statements)

References 34 publications

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“…With the development of minimally invasive surgery, MED technology has gradually become a common method 5 Computational and Mathematical Methods in Medicine for the treatment of lumbar spinal stenosis [36]. It has the advantages of small incision, fast recovery, less bleeding, preservation of spinal soft tissue structure and so on [37].…”

Section: Discussionmentioning

confidence: 99%

Unilateral Biportal Endoscopic Discectomy versus Microendoscopic Discectomy for the Treatment of Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Niu

Zhang

2022

Computational and Mathematical Methods in Medicine

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Objective. In minimally invasive spinal surgery, the treatment of lumbar spinal stenosis with microendoscopic discectomy (MED) or unilateral biportal endoscopic discectomy (UBED) shows effective results, but which is more effective is controversial. Our study aimed to evaluate the efficacy and safety of UBED versus MED in the treatment of lumbar spinal stenosis by a systematic review and meta-analysis, so as to provide reference for the promotion of UBED in clinical practice. Methods. The multiple databases like PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Databases, Chinese BioMedical Database, and Wanfang Database were used to search for the relevant studies. Review Manager 5.4 was adopted to estimate the effects of the results among selected articles. Odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were used to estimate the overall pooled effect. Subgroup analysis, forest plots, funnel plots and Egger’s test for the articles included were also conducted. Results. Three randomized clinical trials and seven cohort studies were finally retrieved, these studies included 685 and 829 patients in the UBED and MED groups, respectively. There were no differences in terms of operation time (MD = -0.92, P =0.72), estimated blood loss (MD = -26.31, P =0.08), complications (MD =0.81, P =0.38) and Oswestry Disability Index (ODI) score (P >0.05 in four subgroup) between the two groups. The visual analog scale (VAS) score of back pain in the UBED group was better than MED group only at 6 months (MD = -0.23, P =0.006) after operation, the VAS score of leg pain in the UBED group was better than that of MED group at 3 mouths (MD = -0.22, P =0.002) and 6 months (MD = -0.24, P =0.006) after operation, the UBED group had a less postoperative length of stay than the MED group (MD = -1.85, P <0.001). The bias analysis showed that there was no potential publication bias in the included literature. Conclusion. This study showed that compared with MED, UBED has the advantages of short hospital stay and good short-term curative effect, but there is no significant difference in long-term efficacy and safety, they can be replaced by each other in clinical application.

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Section: Discussionmentioning

confidence: 99%

Unilateral Biportal Endoscopic Discectomy versus Microendoscopic Discectomy for the Treatment of Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Niu

Zhang

2022

Computational and Mathematical Methods in Medicine

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“…Using the endoscope in MVD for TN offers unparalleled panoramic views and illumination of the neurovascular structures within the CPA and identification of vessel-nerve contact traditionally not seen with a microscope. 24 It can provide the operator with additional vision that reduces the risk of SPV injury. Without endoscopy, the surgeon can use the suction tube in one hand, retracting the upper part of the cerebellum and SPV, and use a dissector in the other hand, pushing the trigeminal nerve to an optimized position, so the REZ of the trigeminal nerve can be seen.…”

Section: Discussionmentioning

confidence: 99%

Preoperative MRI Evaluation of Relationship between Trigeminal Nerve and Superior Petrosal Vein: Its Role in Treating Trigeminal Neuralgia

Xiong

Zhou

Yang

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Objective To assess the value of high-resolution magnetic resonance imaging (MRI) and three-dimensional (3D) reconstruction of the trigeminal nerve and the superior petrosal vein (SPV) in visualizing their anatomical relationship in patients with trigeminal neuralgia (TN). Patients and Methods This study included 97 patients with primary TN who underwent preoperative 3D constructive interference in steady state (CISS) MRI. Image analysis was performed by an independent observer blinded to the operative findings and then compared with surgical data. The 3D reconstruction was assessed dynamically using MIMICS software (Materialise Inc., Leuven, Belgium). Results The 3D relationship between visible structures seen on MRI was consistent with the intraoperative findings in all patients. All cases were divided into three groups by the degree of trigeminal nerve encroachment by SPV. Statistical analysis revealed that the distance from the SPV to the trigeminal nerve was significantly different among the three groups. The diameter of the SPV also differed among the three groups. Conclusion Preoperative 3D imaging provides reliable and detailed information about the intraoperative anatomical relationship between the trigeminal nerve and the SPV. This evaluation is useful for preoperative planning.

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“…Neuroendoscopy is a useful tool that compensates for surgical microscope limitations 21 . Some neurosurgeons have proposed the use of this tool in all MVD surgical procedures [22][23][24] . However, based on our experience and that of other authors 9 , we consider neuroendoscopy should be restricted to cases where the neural pathway is difficult to visualize, or when the area of compression is located at a point of difficult access 21 .…”

Section: Surgical Techniquementioning

confidence: 99%

Minimally invasive asterional approach for microvascular decompression in trigeminal neuralgia

López-Elizalde¹,

Reyes-Velasco²,

Campero³

et al. 2023

GMM

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Objective: Trigeminal neuralgia (TN) is a neuropathic disorder that can be treated surgically. This study aimed to present the surgical findings and the clinical outcomes of 26 patients with TN treated by minimally invasive asterional surgery. Methods: Longitudinal descriptive study. Twenty-six patients with TN underwent minimally invasive asterional surgery. The medical history, surgical findings, therapeutic response, and complications were registered. They were followed for 36 months. Results: Nineteen cases were associated with vascular compression; five were associated with arachnoiditis. The two remaining cases were associated with multiple sclerosis and post-herpetic neuralgia. The pain was substantially reduced in all patients in the immediate postoperative period. At 36 months, in 25 patients, total or acceptable pain control was achieved. In the long term, 22 patients evolved with no permanent complications. Conclusion: The microvascular decompression surgery by an asterional approach is an alternative with similar results to the classic retrosigmoid approach to treat TN, but that adds the benefits of the principles of minimally invasive surgery. Constant efforts need to be made to optimize minimally invasive surgical techniques for TN.

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Endoscopic and Microscopic Microvascular Decompression

Cited by 29 publications

References 34 publications

Unilateral Biportal Endoscopic Discectomy versus Microendoscopic Discectomy for the Treatment of Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Unilateral Biportal Endoscopic Discectomy versus Microendoscopic Discectomy for the Treatment of Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Preoperative MRI Evaluation of Relationship between Trigeminal Nerve and Superior Petrosal Vein: Its Role in Treating Trigeminal Neuralgia

Minimally invasive asterional approach for microvascular decompression in trigeminal neuralgia

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