Endoscopy and Microscopy in the PCA: Two Complementary Procedures during Surgery of Hemifacial Spasm or Trigeminal Neuralgia

Objective: To demonstrate that in pontocerebellar angle (PCA) neurovascular conflict surgery, it is necessary to use alternatively and complementarily microscope and endoscope to remove surely and definitively the conflict. Methods: A total of 115 patients were operated by retrosigmoid approach: 75 for a trigeminal neuralgia and 40 for a hemifacial spasm. Among these, we have selected the most typical cases where the complementarity of the two techniques is indispensable to the operative success. The operating steps and surgical video features are described precisely. Results: With the complementary use of both techniques, the conflicts removal has always been possible and safe. The only rare cases where it has not been, this is due to a particular anatomical arrangement, especially with venous anomaly. Conclusion: Endoscopy and microscopy in the PCA are not exclusive but rather complementary to each other in neuromuscular conflicts.