Endoscope-assisted microvascular decompression for trigeminal neuralgia: technical case report

Microvascular decompression may fail to relieve trigeminal neuralgia because a compressing vessel at the root entry zone may be overlooked during surgery. Alternatively, effective decompression may not always be achieved with the visualization provided by the microscope alone. We theorized that the addition of an endoscope would improve the efficacy of microvascular decompression.

We retrospectively reviewed microvascular decompression of the trigeminal nerve in 114 patients. Before closure, the endoscope was used to inspect the root entry zone. When visualization with the microscope was poor, the endoscope was used to identify an aberrant vessel and to perform or improve the subsequent decompression.

Of 114 patients who underwent microvascular decompression, 113 successfully underwent endoscopy. In 38 patients (33%), endoscopy revealed arteries that were poorly seen (25%) or not seen at all (8%) with the microscope. At a mean follow-up period of 29 months, the pain was completely relieved in 112 patients (99.1%), all of whom were off medication. Complications included trigeminal dysesthesias in nine patients and a wound infection, partial hearing loss, and complete hearing loss in one patient each. The overall complication rate was 9%.

Endoscopy is a simple and safe adjunct to microscopic exploration of the trigeminal nerve. The markedly improved visualization increases the likelihood of identifying the offending vessel and consequently of achieving satisfactory decompression of the nerve. Thus far, the success rate has been high, and the complication profile is comparable to that of other large series.