Abstract
Microvascular decompression of the trigeminal nerve is an accepted and effective means
of treating patients with trigeminal neuralgia in whom compression of the nerve by
a vascular structure is implicated in the pathogenesis of the disease. The current
standard technique uses the binocular operating microscope for all intra-operative
visualization. Posterior fossa endoscopy has demonstrated that the endoscope provides
more comprehensive views of the anatomy of the cerebellopontine angle than does the
operating microscope. To date, endoscopy has only been used to supplement microscopy
in cranial nerve decompression surgery. In this report, we describe our completely
endoscopic surgical technique as we present the case of a patient with trigeminal
neuralgia who underwent successful vascular decompression by this approach. Using
this technique the offending vessel was separated from the nerve with minimal brain
retraction or dissection of surrounding structures. This report represents the first
documented case where the endoscope was used as the exclusive imaging modality for
decompression of the trigeminal nerve. From our experience we conclude that the endoscope's
superior visualization more accurately identifies neurovascular conflicts, and provides
a comprehensive evaluation of the completeness of the decompression. Additionally,
this new method minimizes the risks of brain retraction and extensive dissection often
required for microscopic exposure. From this study we conclude that completely endoscopic
vascular decompression represents the next step forward in the safe and effective
surgical treatment of trigeminal neuralgia.
Key words
Endoscopy - Microvascular Decompression - Trigeminal Neuralgia
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H. K. Shahinian,M. D.
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