DG Journal Club
World Neurosurg. 2022 Jul 8
BACKGROUND Microscopic microvascular decompression of the trigeminal nerve is the gold standard surgical treatment for medically refractory classical trigeminal neuralgia (TN). Endoscopy has significantly advanced surgery and provides enhanced visualisation of the cerebellopontine angle and its critical neurovascular structures. We present our initial experience of fully endoscopic microvascular decompression (e-MVD).
METHODS This retrospective case series investigated e-MVD performed between September 2016 to February 2020 at a single institution. Clinical data including presenting symptomatology, medications, operative findings, postoperative complications and outcomes were recorded. The five-point Barrow Neurological Institute Pain Intensity Score (BNI) was used to quantify the patients’ pain relief.
RESULTS 25 TN patients (M:F 10:15; mean age of 63 [SD: 10.4]) underwent e-MVD during the study period. All patients had a preoperative BNI score 5. The left side was affected in 15 patients. Complications occurred in two patients: both experienced hearing loss and one transient facial weakness seven days after surgery. The facial weakness had resolved by the last follow-up. All patients were completely pain-free (BNI score 1) immediately post-operatively. On latest follow-up, 22 patients have remained pain-free and 3 patients have recurrent pain that is being controlled with medication (BNI score III).
CONCLUSION Our study demonstrates that e-MVD is a safe, possibly effective method of performing MVD with the added benefit of providing improved visualisation of the operative field for the operating surgeon and the surgical team. Larger prospective studies are required to evaluate if performing e-MVD confers any additional benefits in the long-term clinical outcome of TN patients.