Endoscopic Microvascular Decompression

Endoscopes have been used instead of the microscope in the performance of microvascular decompression in patients who were admitted to Barts and The London NHS trust.

To determine whether endoscopic techniques have any advantages over the operating microscope with respect to operative vision, ease of surgery, and patient satisfaction.

A 2- to 3-cm retromastoid linear incision was made and a burr hole was performed to expose the edge of the sigmoid and transverse sinuses. The dural opening was along the line of the sinus, allowing the dura to flap onto the cerebellum, protecting it from the instruments. A 0° endoscope was used to visualize the inferior aspect of the cerebellum, ensuring that no bridging veins were damaged as the cerebellum fell away from the tentorium. The approach was usually not difficult. An excellent view was obtained of the nerve, the root entry zone, Meckel's cave, and the vascular loops around the nerve. Rhoton instruments were generally sufficient; to improve vision into Meckel's cave, a 30° endoscope was generally employed. A shredded Teflon patch was interposed between the nerve and vessel in the normal way. At no time during surgery was fixed retraction needed.

An excellent relief of facial pain was obtained in all cases with some mild return in the early postoperative period in two patients. Wound pain was minimal. Length of stay was shorter than with microsurgery, but the longer term results appear similar.

Endoscopic vascular decompression is a safe, minimally invasive, and effective procedure in trigeminal neuralgia and avoids brain retraction.