Fully Endoscopic Microvascular Decompression for Neurovascular Compression Syndrome: Early Outcomes and Technical Note

Neurovascular compression syndromes (NVCSs) are a series of vascular compression diseases wherein there is usually entrapment or distortion of cranial nerves due to redundant or aberrant culprit vessels. Microvascular decompression (MVD) is an effective treatment for NVCS. However, the global adoption of fully endoscopic MVD (E-MVD) remains limited.

This retrospective study reviewed 105 patients with NVCS (102 cases for initial operation and 3 cases of disease recurrence) who underwent E-MVD. The cohort comprised of 59 hemifacial spasm (HFS), 34 trigeminal neuralgia (TN), and 12 glossopharyngeal neuralgia cases. All patients were followed up by telephone one year postoperatively, focusing on the relief of symptoms and surgical complications such as hearing loss, tinnitus, or vertigo.

In the de novo NVCS group, the pain completely resolved immediately after surgery (from Barrow Neurological Institute grade IV and V to grade 0) in 32 TN patients (32/34, 94.1%) and all 12 glossopharyngeal neuralgia patients (100%), and spasm symptoms disappeared (from Shorr grading III and IV to 0) in 57 HFS patients (96.6%). Three recurrent patients (2 with HFS and 1 with TN) experienced complete symptom relief without reappearance. Additionally, two left HFS patients with preoperative neurogenic hypertension had their blood pressure gradually return to normal levels postoperatively. Postoperative neurological complications included hearing loss, tinnitus, and dysphagia, each occurring in 1 case (2.9%). Other complications included meningitis (5/105, 4.8%), cerebrospinal fluid leakage (1/105, 1%), and incisional fat liquefaction (2/105, 1.9%).

E-MVD represents a significant advancement in the treatment of NVCS, offering a promising alternative to traditional strategies.