Introduction: A fully endoscopic microvascular decompression (E-MVD) has several possible advantages over conventional microscopic microvascular decompression (MVD). Although validation of the technique requires long term outcomes, early outcomes should at least equal those of conventional microsurgery. We present our own single surgeon and institution experience.
Methods: This is a retrospective review of all patients treated by a single surgeon over a 30 month period for cranial nerve compression disorder.
Results: 84 patients (M/F:29/55) were identified. Majority of procedures were performed for TN (n=72), HFS (n=9), geniculate/glossopharyngeal neuralgia (n=3). In the first fifteen months 42% (n=16) of procedures were performed purely endoscopically. In the second fifteen months 76% (n=36) were performed purely endoscopically. Rates of vascular contact did not differ between MVD or E-MVD. Overall vascular compression was not identified in 3.6% (n=3) of patients. Of the 72 patients with trigeminal neuralgia, 8.3% (n=6) patients were BNI class IV or V at last follow-up. There was no statistically significant difference between MVD and E-MVD (Kruskal Wallis, p>0.05). Of the nine patients with HFS, all achieved excellent relief of HFS. Complications were not significantly different between the two groups. Overall rate was 4.7% (n=4) with wound infection (n=1), CSF otorrhea (n=1), and temporary facial palsy in two HFS E-MVD patients.
Conclusions: A purely endoscopic microvascular decompression (E-MVD) appears to be a safe and effective alternative to conventional MVD. The surgical efficacy and complication rates do not seem to be significantly different between the two. Over a two and a half year period, an evolution of technique can be safely instituted into practice. Technique including use of pneumatic holding arm, nuances to avoid clashing of instruments, and unique tools will be discussed.
Patient Care: Minimally Invasive Methods of surgical care gradually lead to better patient tolerance and recovery.
Learning Objectives: To review outcomes of microvascular decompression technique using purely endoscopic visualization
References: Lang SS, Chen HI, Lee JYK. ORL J Otorhinolaryngol Relat Spec. 2012;74(6):293-8. doi: 10.1159/000342795. Epub 2012 Dec 12.
Endoscopic microvascular decompression: a stepwise operative technique.