Endoscopic Vascular Decompression versus Microvascular Decompression of the Trigeminal Nerve

Abstract

Microvascular decompression (MVD) is a highly accepted and effective method for treatment of patients with trigeminal neuralgia in whom compression of the nerve by a vascular structure is implicated in the pathogenesis of the disease. However, recent reports have highlighted the advantages of the endoscope in visualizing structures within the cerebellopontine angle. Additional research, using the endoscope to supplement the microscopic procedure, has demonstrated improved localization of neurovascular conflicts. In this report we present the results of our series utilizing a fully endoscopic vascular decompression (EVD) technique, and compare these results to those published for microvascular decompression. From September 1999 until October 2004, 255 patients underwent endoscopic vascular decompression of the trigeminal nerve. These patients' records were retrospectively reviewed, and additional data from follow-up visits were collected and analyzed to ascertain success rates and review the incidence of complications. From a total of 255 patients who underwent EVD of the trigeminal nerve we noted an initial, complete, postoperative success rate in 95 % of patients. Initial, being defined as within the first 3 months postoperative, and “complete” being judged if the patient reported 98 % relief of pain postoperatively without the need for medication (Barker's classification). Additionally, we documented a 93 % complete success rate for 118 patients who completed at least a three-year follow-up period. Complication rates were compared to those reported for MVD. There were no serious complications or mortality in this series. We conclude that EVD is a safe and effective method to remove neurovascular conflicts related to the trigeminal nerve. The results of this series demonstrate an improved rate of trigeminal neuralgia relief with EVD when compared to MVD, a lower incidence of complications and a better outcome.

Key words

Endoscopic - microvascular decompression - trigeminal neuralgia - facial pain

References

• 1 Blitzer A. Pharmacotherapy and trigeminal neuralgia.  Anesth Prog. 1969;  16 15-17
• 2 Tovi D, Leivy D M, Krueger E. Trigeminal neuralgia. Current trends in treatment.  NY State J Med. 1969;  69 564-567
• 3 Doyen E. In: Surgical Therapeutics and Operative Techniques. London, UK: Balliere, Tindall, and Cox, Eds 1917: 599-602
• 4 Dandy W. Concerning the cause of trigeminal neuralgia.  Am J Surg. 1934;  24 447-455
• 5 Aksik I. Microneural decompression operations in the treatment of some forms of cranial rhizopathy.  Acta Neurochir. 1993;  125 64-74
• 6 Apfelbaum R I. Surgery for tic douloureux.  Clin Neurosurg. 1983;  31 351-368
• 7 Barker 2nd F G, Jannetta P J, Bissonette D J, Larkins M V, Jho H D. The long-term outcome of microvascular decompression for trigeminal neuralgia [see comments].  N Engl J Med. 1996;  334 1077-1083
• 8 Breeze R, Ignelzi R J. Microvascular decompression for trigeminal neuralgia. Results with special reference to the late recurrence rate.  J Neurosurg. 1982;  57 487-490
• 9 Broggi G, Ferroli P, Franzini A, Servello D, Dones I. Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis.  J Neurol Neurosurg Psychiatry. 2000;  68 59-64
• 10 Cutbush K, Atkinson R L. Treatment of trigeminal neuralgia by posterior fossa microvascular decompression.  Aust NZ J Surg. 1994;  64 173-176
• 11 Dahle L, von Essen C, Kourtopoulos H, Ridderheim P A, Vavruch L. Microvascular decompression for trigeminal neuralgia.  Acta Neurochir. 1989;  99 109-112
• 12 Jannetta P J. Observations on the etiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia. Definitive microsurgical treatment and results in 117 patients.  Neurochirurgia (Stuttg). 1977;  20 145-154
• 13 Jannetta P J. Vascular compression is the cause of trigeminal neuralgia.  APS Journal. 1993;  2 217-227
• 14 Klun B. Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal neuralgia: personal experience with 220 patients.  Neurosurgery. 1992;  30 49-52
• 15 Kolluri S, Heros R C. Microvascular decompression for trigeminal neuralgia. A five-year follow-up study.  Surg Neurol. 1984;  22 235-240
• 16 Kondo A. Follow-up results of microvascular decompression in trigeminal neuralgia and hemifacial spasm.  Neurosurgery. 1997;  40 46-51; discussion 51 - 52
• 17 Lovely T J, Jannetta P J. Microvascular decompression for trigeminal neuralgia. Surgical technique and long-term results.  Neurosurg Clin N Am. 1997;  8 11-29
• 18 Ryu H, Yamamoto S, Sugiyama K, Yokota N, Tanaka T. Neurovascular decompression for trigeminal neuralgia in elderly patients.  Neurol Med Chir (Tokyo). 1999;  39 226-229; discussion 229 - 230
• 19 Sun T, Saito S, Nakai O, Ando T. Long-term results of microvascular decompression for trigeminal neuralgia with reference to probability of recurrence.  Acta Neurochir. 1994;  126 144-148
• 20 Hanakita J, Kondo A. Serious complications of microvascular decompression operations for trigeminal neuralgia and hemifacial spasm.  Neurosurgery. 1988;  22 348-352
• 21 Kureshi S A, Wilkins R H. Posterior fossa reexploration for persistent or recurrent trigeminal neuralgia or hemifacial spasm: surgical findings and therapeutic implications.  Neurosurgery. 1998;  43 1111-1117
• 22 Lee S H, Levy E I, Scarrow A M, Kassam A, Jannetta P J. Recurrent trigeminal neuralgia attributable to veins after microvascular decompression.  Neurosurgery. 2000;  46 356-361; discussion 361 - 362
• 23 Liao J J, Cheng W C, Chang C N, Yang J T, Wei K C, Hsu Y H. et al . Reoperation for recurrent trigeminal neuralgia after microvascular decompression.  Surg Neurol. 1997;  47 562-568; discussion 568 - 570
• 24 Rath S A, Klein H J, Richter H P. Findings and long-term results of subsequent operations after failed microvascular decompression for trigeminal neuralgia.  Neurosurgery. 1996;  39 933-938; discussion 938 - 940
• 25 Walchenbach R, Voormolen J H, Hermans J. Microvascular decompression for trigeminal neuralgia: a critical reappraisal.  Clin Neurol Neurosurg. 1994;  96 290-295
• 26 Magnan J, Sanna M. Endoscopy in Neuro-Otology. New York: Thieme 1999
• 27 Jennings C R, O'Donoghue G M. Posterior fossa endoscopy [editorial].  J Laryngol Otol. 1998;  112 227-229
• 28 Magnan J, Chays A, Lepetre C, Pencroffi E, Locatelli P. Surgical perspectives of endoscopy of the cerebellopontine angle.  Am J Otol. 1994;  15 366-370
• 29 O'Donoghue G M, O'Flynn P. Endoscopic anatomy of the cerebellopontine angle.  Am J Otol. 1993;  14 122-125
• 30 Spencer W R, Das K, Nwagu C, Wenk E, Schaefer S D, Moscatello A. et al . Approaches to the sellar and parasellar region: anatomic comparison of the microscope versus endoscope.  Laryngoscope. 1999;  109 791-794
• 31 Magnan J, Caces F, Locatelli P, Chays A. Hemifacial spasm: endoscopic vascular decompression.  Otolaryngol Head Neck Surg. 1997;  117 308-314
• 32 Jarrahy R, Berci G, Shahinian H K. Endoscope-assisted microvascular decompression of the trigeminal nerve.  Otolaryngol Head Neck Surg. 2000;  123 218-223
• 33 Jarrahy R, Eby J B, Cha S T, Shahinian H K. Fully endoscopic vascular decompression of the trigeminal nerve. Minim Invas.  Neurosurg. 2002;  45 32-35
• 34 Yamaki T, Hashi K, Niwa J, Tanabe S, Nakagawa T, Nakamura T. et al . Results of reoperation for failed microvascular decompression.  Acta Neurochir. 1992;  115 17