Full Endoscopic Vascular Decompression in Trigeminal Neuralgia: Experience of 230 Patients

Although most surgeons are using endoscopy as an adjunct to microscopy in microvascular decompression, a full endoscopic technique is less commonly performed. The present study is aimed to evaluate results of 230 patients of endoscopic vascular decompression.

A retrospective study was carried out in a tertiary care hospital. Patients with typical neuralgia, with or without preoperatively detected vascular compression, were advised to undergo vascular decompression.

Maxillary and mandibular division were involved in 116 and 93 patients, respectively. Superior cerebellar (n = 174) artery was most common vascular conflict followed by anterior inferior cerebellar artery (n = 96). Tortuous basilar artery and small veins were possible causes of neuralgia in 1 and 2 patients, respectively. Single- and double-vessel conflict were observed in 173 and 50 patients, respectively. The compressing vessel was placed anterior to the trigeminal nerve in 39 patients. An arterial loop was in contact with the nerve, producing grooving, and displacing the nerve in 215, 35, and 21 patients, respectively. Complete, satisfactory, and no relief of pain were observed in 204 (88.7%), 11 (5.8%), and 15 (6.5%) patients, respectively. Recurrence was observed in 25 patients at an average follow-up of 60 months. Temporary complications included trigeminal dysesthesia, vertigo, facial paresis, CSF leak, and reduced hearing in 9, 8, 8, 7, and 3 patients, respectively.

Endoscopic vascular decompression is a safe and efficient alternative technique to endoscopic assisted microvascular decompression provided surgeon is experienced in endoscopic surgery. It is helpful in identification of all offending vessels including the double vessel, and anterior compression without brain and nerve retraction.