Endoscopic Versus Microscopic Microvascular Decompression for Trigeminal Neuralgia: A Prospective Controlled Study.

Area of Science:

• Neurosurgery
• Minimally Invasive Procedures
• Pain Management

Background:

• Trigeminal neuralgia (TN) is a debilitating condition often treated with microvascular decompression (MVD).
• Endoscope-assisted microvascular decompression (EA-MVD) shows promise, but comparative evidence is limited.

Purpose of the Study:

• To compare the efficacy and safety of EA-MVD versus standard microscopic microvascular decompression (M-MVD) for TN treatment.
• To evaluate outcomes including pain relief, identification of causative vessels, and complication rates.

Main Methods:

• A prospective controlled study involving 52 patients with TN.
• Patients were randomized to undergo either EA-MVD (n=23) or M-MVD (n=29).
• Outcomes assessed included pain intensity (VAS, BNI scale), operative details, and complications over a >=12-month follow-up.

Main Results:

• Both EA-MVD and M-MVD groups achieved significant and comparable pain relief at 12 months (91.3% vs 93.1% pain-free/nearly pain-free).
• EA-MVD identified a higher incidence of multiple offending vessels (52.2% vs 17.2%, P=0.038) due to enhanced visualization.
• EA-MVD had longer operative times (158 vs 144 min) but shorter hospital stays (6 vs 8 days); no mortality or endoscope-specific severe adverse events occurred.

Conclusions:

• EA-MVD and M-MVD demonstrate similar efficacy in providing pain relief for trigeminal neuralgia.
• EA-MVD offers superior visualization, potentially identifying more causative vessels.
• Further research is needed due to the study's single-center nature and small sample size.