Fully endoscopic microvascular decompression for trigeminal neuralgia: our technical note and early outcomes

Abstract

Purpose: Microscopic microvascular decompression (MVD) has been considered as a curative and reliable method for primary trigeminal neuralgia (TN) treatment for decades. However, the omission of offending vessels due to inadequate visualization often results in failure or recurrence after operation. Endoscope can provide bright illumination and panoramic view which enhance the visualization of posterior fossa. The study presented here is to evaluate the advantages of fully endoscopic microvascular decompression for TN therapy and describe our operative technical note. Methods: From January 2020 to January 2022, 95 primary TN patients underwent fully endoscopic MVD operation performed by the same surgeon and assistant in our department. The assistant held the endoscope and the surgeon operated. Brain stem auditory evoked potentials (BEMPs) was routinely monitored. For very patient, the neurovascular conflict was identified and obtained complete decompression. Barrow neurological institute (BNI) pain intensity score was used to evaluate the facial pain degree. The intra-operative findings, postoperative outcomes, and complications were analyzed. Results: Immediately after operations, 93 patients (97.9%) achieved complete pain relief (BNI score of I). 2 patients (2.1%) still had some pain, but it can be adequately controlled with medicine (BNI score of III). During 12–36 months follow-up, recurrence was found in 3 patients (3.2%), including one patient (1.1%) with BNI score of II and 2 patients (2.1%) with BNI score of III. Complications were found in 5 patients (5.3%), including facial numbness in 3 patients (3.2%), vertigo in one patient (1.1%), and headache in one patient (1.1%). There was no death, stroke, hearing impairment, facial paralysis, or other complications. Conclusions: Fully endoscopic MVD is a safe and effective method to treat TN. It provides bright illumination and panoramic view for surgeons to observe neurovascular conflicts in deep place of the cerebellopontine angle (CPA) that is very helpful in avoiding omission of offending vessels and injury of adjacent neurovascular structures.