Application of the semidiving technique in fully endoscopic microvascular decompression.

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery
• Neurology

Background:

• Microvascular decompression (MVD) is a primary treatment for hemifacial spasm (HFS) and trigeminal neuralgia (TN).
• Fully endoscopic MVD (E-MVD) is gaining traction, prompting innovation in endoscopic techniques.
• The endoscopic diving technique, used in pituitary surgery, inspired the development of the semidiving technique.

Purpose of the Study:

• To evaluate the safety and feasibility of the novel endoscopic semidiving technique in E-MVD for HFS and TN.
• To compare the outcomes of the semidiving technique against the nonsemidiving technique in E-MVD.

Main Methods:

• A prospective study involving 359 patients undergoing E-MVD for HFS or TN.
• Patients were divided into nonsemidiving and semidiving technique groups.
• Surgical data, outcomes, complications, and recurrence rates were analyzed and compared between groups.

Main Results:

• For HFS patients, the semidiving technique showed comparable effectiveness (92.9%) to the nonsemidiving technique (95.6%) but significantly reduced permanent hearing loss (0% vs. 5.9%).
• In TN patients, no significant differences in effectiveness or complications were found between the groups.
• The semidiving technique shortened surgical duration and hospitalization for HFS patients.

Conclusions:

• The endoscopic semidiving technique is safe and feasible for E-MVD in HFS and TN.
• It offers reduced hearing loss and aligns with enhanced recovery after surgery (ERAS) principles for HFS patients.
• This technique maintains surgical quality and efficacy while minimizing cerebellar retraction and mechanical damage.