Endoscopic microvascular decompression for primary trigeminal neuralgia: surgical experience and early outcomes

Objective: This study aimed to investigate the clinical efficacy and early outcomes of endoscopic microvascular decompression (MVD) for primary trigeminal neuralgia (TN) and provide clinical experience for the application of full endoscopic techniques in MVD surgery. Methods: This study retrospectively collected medical records of patients who underwent microvascular decompression (MVD) surgery at our institution between January 2020 and January 2023. According to predefined inclusion and exclusion criteria, a total of 137 patients were ultimately included in the study. To evaluate the severity of facial pain in these patients, we utilized the Barrow Neurological Institute (BNI) pain intensity rating system. Additionally, this study analyzed and compared the clinical outcomes of MVD procedures performed endoscopically versus those performed under microscopy. Results: There were no statistically significant differences between endoscopic and microscopic microvascular decompression (MVD) in terms of postoperative hospital stay, recurrence rate, complication incidence, and surgical duration (P > 0.05). However, regarding the efficacy of treatment, the effectiveness rate after endoscopic MVD was superior to that of microscopic MVD, with a statistically significant difference observed between the two groups (P < 0.05). Conclusion: Endoscopic microvascular decompression (MVD) for primary trigeminal neuralgia is a safe and effective treatment, with the critical success factor being the accurate localization of the vessel compressing the nerve. Compared to traditional microscopic MVD, endoscopic MVD shows superior postoperative outcomes, offering wide-angle and multi-angle views along with close-up inspection capabilities. However, it requires attention to overcoming limitations such as a lack of stereoscopic vision and potential blind spots.