Fully endoscopic microvascular decompression: our early experience

Abstract

Background. Microvascular decompression (MVD) is a widely accepted treatment for neurovascular disorders associated with facial pain and spasm. The endoscope has rapidly become a standard tool in neurosurgical procedures; however, its adoption in lateral approaches to the posterior fossa has been slower. The endoscope is used primarily to assist conventional microscopic techniques. We are interested in developing fully endoscopic approaches to the cerebellopontine angle, and here, we describe our preliminary experience with this procedure for MVD. Methods. A retrospective review of our two-year experience from 2011 to 2012, transitioning from using conventional microscopic techniques to endoscope-assisted microsurgery to fully endoscopic MVD, is provided. We also reviewed our preliminary outcomes during this transition. Results. There was no difference in the surgical duration of these three procedures. In addition, the majority of procedures performed in 2012 were fully endoscopic, suggesting the ease of incorporating this solo tool into practice. Pain outcomes of fully endoscopic MVD appear to be very similar to those of both conventional and endoscope-assisted MVDs. Complications occurred in all groups at equally low rates. Conclusion. Fully endoscopic MVD is both safe and effective. By enhancing visualization of structures within the cerebellopontine angle, endoscopy may prove to be a valuable adjunct or alternative to conventional microscopic approaches.

Figure 1

Endoscopic view of burr hole/craniectomy site (a) with subsequent closure and placement of titanium mesh burr hole cover (b).

Figure 2

Endoscopic view of the vascular compression associated with cases of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. The left panel demonstrates compression of CN 5 by the superior cerebellar artery (top) with subsequent decompression with Teflon (bottom). The middle panel illustrates compression of CN 7 by the anterior inferior cerebellar artery (top). Note that CN 7 is found on the inferior aspect of CN 8, which requires decompression deep to the CN 7-8 complex (bottom). The right panel demonstrates a case of glossopharyngeal neuralgia caused by vertebral artery contact (top) and the associated decompression (bottom). Cranial nerve (CN); superior cerebellar artery (SCA); anterior inferior cerebellar artery (AICA); vertebral artery (VA).