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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(01): 193-200
DOI: 10.4103/ajns.AJNS_279_17
Original Article

Endoscope-assisted microneurosurgery for neurovascular compression syndromes: Basic principles, methodology, and technical notes

Sabino Luzzi
1   Department of Neurosurgery, San Salvatore City Hospital, L'Aquila
,
Mattia Del Maestro
2   Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila
,
Donatella Trovarelli
3   Department of Anesthesiology, San Salvatore City Hospital, L'Aquila
,
Danilo De Paulis
1   Department of Neurosurgery, San Salvatore City Hospital, L'Aquila
,
Soheila Dechordi
1   Department of Neurosurgery, San Salvatore City Hospital, L'Aquila
,
Hambra Di Vitantonio
1   Department of Neurosurgery, San Salvatore City Hospital, L'Aquila
,
Valerio Di Norcia
1   Department of Neurosurgery, San Salvatore City Hospital, L'Aquila
,
Daniele Millimaggi
1   Department of Neurosurgery, San Salvatore City Hospital, L'Aquila
,
Alessandro Ricci
1   Department of Neurosurgery, San Salvatore City Hospital, L'Aquila
,
Renato Galzio
1   Department of Neurosurgery, San Salvatore City Hospital, L'Aquila
2   Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila
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Background: Microscopic microvascular decompression (MVD) has a low but not negligible failure rate due to some missed conflicts, especially in case of multiple offending vessels. The reported study is aimed to assess the principles, methodology, technical notes, and effectiveness of the endoscope-assisted (EA) MVD for neurovascular compression syndromes (NVCS) in the posterior fossa. Materials and Methods: A series of 43 patients suffering from an NVCS and undergone to an EA MVD were retrospectively reviewed. Syndromes were trigeminal neuralgia in 25 cases, hemifacial spasm in nine cases, positional vertigo in six cases, glossopharyngeal neuralgia in two cases, and spasmodic torticollis in one case. In all cases, a 0°–30° specially designed endoscope was inserted into the surgical field to find/treat those conflicts missed by the microscopic exploration. Each procedure was judged in terms of the effectiveness of the adjunct of the endoscope according to a three types classification system: Type I – improvement in the visualization of the nerve's root entry/exit zone; Type II – endoscopic detection of one or more conflicts involving the ventral aspects of the nerve and missed by the microscope; Type III – endoscope-controlled release of the neurovascular conflict otherwise difficult to treat under the only microscopic view. Results: A total of 55 conflicts were found and treated. Twenty-eight procedures were classified as Type I, nine as Type II, and six as Type III. All the patients had a full recovery from their symptoms. Conclusions: In selected cases, EA MVD offers some advantages in the detection and treatment of neurovascular conflicts in the posterior fossa.

Key-words:

Endoscope-assisted microneurosurgery - glossopharyngeal neuralgia - hemifacial spasm - microvascular decompression - trigeminal neuralgia

Financial support and sponsorship

Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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