Minim Invasive Neurosurg 2011; 54(03): 110-114
DOI: 10.1055/s-0031-1283129
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Vascular Decompression of the Trigeminal Nerve

Y. R. Yadav
1   Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
,
V. Parihar
1   Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
,
M. Agarwal
1   Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
,
S. Sherekar
1   Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
,
P. Bhatele
1   Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
23. August 2011 (online)

Abstract

Background:

Microvascular decompression is an effective method of treatment in trigeminal neuralgia. It may fail if a compressing vessel is overlooked during surgery. The endoscope has an edge over the microscope in visualizing such conflicts.

Materials and Methods:

This is a prospective study of 51 patients. Preoperative computed tomography and magnetic resonance imaging scans were performed in all the cases. A 4 − 5 cm retroauricular skin incision was made and an about 3 cm craniectomy was performed. A 0° 4 mm telescope supported by the holder was used after the dural opening. A 2 by 6 cm sheet prepared from hand gloves was used to protect the brain. A Karl Storz 30° telescope was used for the visualization of the trigeminal nerve from the pons to Meckel’s cave and dissection of the anterior conflict. Small pieces of dura patch were interposed between the nerve and the vessel. The microscope was not used at any stage. Post-operative infection, cerebrospinal fluid leak, cranial nerve deficit, failure of procedure in terms of pain relieves and recurrences of pain were recorded. The follow-up period ranged from 24 to 55 months with an average of 36 months.

Results:

There was no mortality or any major permanent complications. The duration of stay ranged from 3 to 10 days with an average of 3.6 days. The pain was relieved in 48 patients.

Conclusion:

Endoscopic vascular decompression is an effective and safe alternative to endoscopic assisted microvascular decompression in trigeminal neuralgia.

 
  • References

  • 1 Teo C, Nakaji P, Mobbs RJ. Endoscope-assisted microvascular decompression for trigeminal neuralgia: technical case report. Neurosurgery 2006; 59 (4 Suppl 2) ONSE489-ONSE490 ; discussion ONSE490
  • 2 Rak R, Sekhar LN, Stimac D et al. Endoscope-assisted microsurgery for microvascular compression syndromes. Neurosurgery 2004; 54: 876-881 discussion 881–883
  • 3 Balansard ChF, Meller R, Bruzzo M et al. Trigeminal neuralgia: results of microsurgical and endoscopic-assisted vascular Decompression. Ann Otolaryngol Chir Cervicofac 2003; 120: 330-337
  • 4 Jarrahy R, Berci G, Shahinian HK. Endoscope-assisted microvascular decompression of the trigeminal nerve. Otolaryngol Head Neck Surg 2000; 123: 218-223
  • 5 Miyazaki H, Deveze A, Magnan J. Neuro-otologic surgery through minimally invasive retrosigmoid approach: endoscope assisted microvascular decompression, vestibular neurotomy, and tumor removal. Laryngoscope 2005; 115: 1612-1617
  • 6 El-Garem HF, Badr-El-Dine M, Talaat AM et al. Endoscopy as a tool in minimally invasive trigeminal neuralgia surgery. Otol Neurotol 2002; 23: 132-135
  • 7 Chen MJ, Zhang WJ, Yang C et al. Endoscopic neurovascular perspective in microvascular decompression of trigeminal neuralgia. J Craniomaxillofac Surg 2008; 36: 456-461
  • 8 King WA, Wackym PA, Sen C et al. Adjunctive use of endoscopy during posterior fossa surgery to treat cranial neuropathies. Neurosurgery 2001; 49: 108-115 discussion 115–116
  • 9 Abdeen K, Kato Y, Kiya N et al. Neuroendoscopy in microvascular decompression for trigeminal neuralgia and hemifacial spasm: technical note. Neurol Res 2000; 22: 522-526
  • 10 Kabil MS, Eby JB, Shahinian HK. Endoscopic vascular decompression versus microvascular decompression of the trigeminal nerve. Minim Invas Neurosurg 2005; 48: 207-212
  • 11 Jarrahy R, Eby JB, Cha ST et al. Fully endoscopic vascular decompression of the trigeminal nerve. Minim Invas Neurosurg 2002; 45: 32-35
  • 12 Artz GJ, Hux FJ, Larouere MJ et al. Endoscopic vascular decompression. Otol Neurotol 2008; 29: 995-1000
  • 13 Barker FG, Jannetta PJ, Bissonette DJ et al. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 1996; 334: 1077-1083
  • 14 Ramesh VG, Premkumar G. An anatomical study of the neurovascular relationships at the trigeminal root entry zone. J Clin Neurosci 2009; 16: 934-936
  • 15 Ramnarayan R, Mackenzie I. Brain-stem auditory evoked responses during microvascular decompression for trigeminal neuralgia: predicting post-operative hearing loss. Neurol India 2006; 54: 250-254
  • 16 Kabatas S, Albayrak SB, Cansever T et al. Microvascular decompression as a surgical management for trigeminal neuralgia: a critical review of the literature. Neurol India 2009; 57: 134-138