Preliminary Report of Fully Endoscopic Microvascular Decompression.

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery

Background:

• Microscopic microvascular decompression (MVD) is a standard treatment for medically refractory hemifacial spasm (HFS) and trigeminal neuralgia.
• The advent of endoscopic technology offers potential advantages for MVD procedures.

Purpose of the Study:

• To explore the safety and efficacy of the fully endoscopic microvascular decompression (E-MVD) technique.
• To compare E-MVD outcomes with traditional microscopic MVD.

Main Methods:

• A retrospective study of 25 patients with HFS undergoing fully E-MVD by a single neurosurgeon.
• Assessment of intraoperative neurophysiological monitoring and clinical outcomes post-surgery and at follow-up.
• Evaluation of complications including facial palsy, hearing loss, and CSF leakage.

Main Results:

• Anterior inferior cerebellar artery (AICA) was the most common offending vessel (60.0%).
• 40.0% of patients had pre-operative facial palsy, with 32.0% experiencing delayed palsy that fully recovered.
• All patients were symptom-free post-surgery, with a low rate of permanent complications (one case of high-frequency hearing loss).

Conclusions:

• Fully E-MVD demonstrates comparable clinical outcomes and complication rates to microscopic MVD.
• E-MVD offers advantages such as a shorter operation time, panoramic view, and smaller craniectomy.
• Fully E-MVD is a viable alternative in the endoscopic era, despite a learning curve.