Endoscopic neurovascular perspective in microvascular decompression of trigeminal neuralgia

Purpose: To evaluate the advantages of endoscopic assistance in microvascular decompression (MVD) for the treatment of trigeminal neuralgia (TGN). Methods: One hundred and sixty-seven patients suffering from TGN were treated by MVD from October 2003 to December 2006. The operating microscope was used in conjunction with a 30 degrees effect endoscope to diagnose neurovascular compression (NVC). Results: The type and grade of NVC were determined in all cases. 85.26% of neurovascular conflicts were diagnosed with the microscope alone. An additional 14.76% could be diagnosed with the assistance of the endoscope. 96.79% of patients experienced immediate relief of pain. Conclusions: MVD is a highly effective treatment for TGN. Endoscopes are very useful during the procedures. They increase the clarity of the surgical field and they enable panoramic visualization in areas that are blind to the direct field of view of the operating microscope. A significant percentage of neurovascular conflicts would be missed at surgery without endoscopic assistance. (C) 2008 European Association for Cranio-Maxillofacial Surgery