Fully endoscopic microvascular decompression for the treatment of hemifacial spasm, trigeminal neuralgia, and glossopharyngeal neuralgia: a retrospective study

Abstract

Background Microvascular decompression (MVD) is already the preferred surgical treatment for medically refractory neurovascular compression syndromes (NVC) such as hemifacial spasm (HFS), trigeminal neuralgia (TN), and glossopharyngeal neuralgia (GPN). Endoscopy has significantly advanced surgery and provides enhanced visualization of MVD. The aim of this study is to analyze the efficacy and safety of fully endoscopic microvascular decompression (E-MVD) for the treatment of HFS, TN, and GPN, as well as to present our initial experience. Materials and methods This retrospective case series investigated fully E-MVD performed in 248 patients (123 patients with HFS, 115 patients with TN, and 10 patients with GPN ) from December 2008 to October 2021 at a single institution. The operation duration, clinical outcomes, responsible vessels, intra- and postoperative complications, and recurrences were recorded. Preoperative and immediate postoperative magnetic resonance imaging (MRI) and computerized tomography (CT) were performed for imageological evaluation. The Shorr grading and Barrow Neurological Institute (BNI) pain score were used to evaluate clinical outcomes. The efficacy, safety, and risk factors related to the recurrence of the operation were retrospectively analysed, and the surgical techniques of fully E-MVD were summarised. Results A total of 248 patients (103 males) met the inclusion criteria and underwent fully E-MVD were retrospectively studied. The effective rate of 123 patients with HFS was 99.1%, of which 113 cases were completely relieved and 9 cases were significantly relieved. The effective rate of 115 patients with TN was 98.9%, of which 105 cases had completely pain relieved after surgery, 5 cases had significant pain relieved, 4 cases had partial pain relieved but still needed to be controlled by medication. The effective rate of 10 patients with GPN was 100%, 10 cases of GPN were completely relieved after surgery. As for complications, temporary facial numbness occurred in 4 cases, temporary hearing loss in 5 cases, dizziness with frequent nausea and vomiting in 8 cases, headache in 12 cases, and no cerebral hemorrhage, intracranial infection, and other complications occurred. Follow-up ranged from 3 to 42 months, with a mean of 18.6 ± 3.3 months. There were 4 cases of recurrence of HFS and 11 cases of recurrence of TN. The other effective patients had no recurrence or worsening of postoperative symptoms. The cerebellopontine angle (CPA) area ratio (healthy/affected side), the length of disease duration, and the type of responsible vessels are the risk factors related to the recurrence of HFS, TN, and GPN treated by fully E-MVD. Conclusions In this retrospective study, our results suggest that the fully E-MVD for the treatment of NVC such as HFS, TN, and GPN, is a safe and effective surgical method. Fully E-MVD for the treatment of NVC has advantages and techniques not available with microscopic MVD, which may reduce the incidence of surgical complications while improving the curative effect and reducing the recurrence rate.

Fully endoscopic microvascular decompression for hemifacial spasm: a clinical study and analysis

“…The most frequent complications associated with MVD treatment for HFS are facial nerve paralysis and hearing loss, followed by instances of intracranial infection and wound-related issues, among others [ 20 , 21 ]. Peng et al [ 22 ] confirmed that fully endoscopic MVD surgery can reduce recurrence and complications, which is consistent with the results of this study. This may be because fully endoscopic MVD surgery has a better field of vision under the guidance of neuroendoscopy and can display the compression position more clearly through the high Telfon gasket, guiding the surgeon to rapidly and accurately relieve the compression.…”

Endoscopically Assisted Exoscopic Surgery for Microvascular Decompression of the Trigeminal Nerve with Intraoperative Use of Indocyanine Green

“…The relapse rate in the endoscopic treatment group was 5% lower, while complications such as postoperative CSF leak were similar [28]. Peng et al [29] in 2023 described the following benefits of complete endoscopic treatment, which can be resumed in 4 points: (1) the different angles of the endoscope lens and the controlled depth of penetration of the endoscope provide a panoramic view of the cerebellopontine angle with 360 • assessment of the neurovascular conflict and avoiding the blind spots of traditional microscopy; (2) endoscopic visualization allows protector installation under direct visual control with circumferential positioning verification; (3) endoscopic decompression is possible without grinding away the petrosal tubercle; and (4) endoscope allows to assess the reliability of the installation of the protector after filling the cerebellopontine angle with cerebrospinal fluid.…”