Related Experiment Video
Updated: Feb 18, 2026
10:35
Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
47.4K
Keyhole retrosigmoid approach for microvascular decompression surgery: systematic review and single-arm meta-analysis
Valentin F Weiger1, Florian S Halbeisen2, Felipe Constanzo3
1Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, Basel, 4031, Switzerland. valentin.we@live.com.
Neurosurgical Review
|February 16, 2026
Summary
The keyhole retrosigmoid approach for microvascular decompression (MVD) surgery is safe and effective for treating trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. This minimally invasive technique offers high symptom relief rates with acceptable complication risks.
Area of Science:
- Neurosurgery
- Minimally Invasive Procedures
- Neurology
Background:
- Microvascular decompression (MVD) is a standard treatment for cranial nerve compression syndromes.
- Traditionally, MVD is performed via a retrosigmoid craniotomy, a larger surgical opening.
- Smaller, keyhole approaches are gaining traction, but evidence needs synthesis.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of keyhole retrosigmoid MVD (≤2 cm).
- To assess symptom relief and complication rates in patients with trigeminal neuralgia (TN), hemifacial spasm (HFS), or glossopharyngeal neuralgia (GPN).
Main Methods:
- Systematic review and meta-analysis of PubMed and Embase databases.
- Inclusion of studies on first-time retrosigmoid keyhole MVD (≤2 cm) in adults.
- Pooled estimates using random-effects single-arm meta-analysis; quality assessed by MINORS.
Main Results:
- 32 publications (93.7% retrospective) involving 5,883 patients were analyzed.
- High complete symptom resolution rates: 89.8% for TN, 91.1% for HFS, 88.7% for GPN.
- Overall complication rate was 13.9%, with permanent neurological deficits in 4.7% (primarily cranial nerve deficits).
Conclusions:
- Keyhole retrosigmoid MVD is a safe and effective minimally invasive surgical option.
- The approach demonstrates high success rates for symptom relief in TN, HFS, and GPN.
- Further comparative studies are recommended to evaluate keyhole versus standard craniotomy advantages.
