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

Sabino Luzzi; Mattia Del Maestro; Donatella Trovarelli; Danilo De Paulis; Soheila Dechordi; Hambra Di Vitantonio; Valerio Di Norcia; Daniele Millimaggi; Alessandro Ricci; Renato Galzio

doi:10.4103/ajns.AJNS_279_17

Asian Journal of Neurosurgery, Table of Contents

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

Authors

Sabino Luzzi

¹Department of Neurosurgery, San Salvatore City Hospital, L'Aquila
Mattia Del Maestro

²Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila
Donatella Trovarelli

³Department of Anesthesiology, San Salvatore City Hospital, L'Aquila
Danilo De Paulis

¹Department of Neurosurgery, San Salvatore City Hospital, L'Aquila
Soheila Dechordi

¹Department of Neurosurgery, San Salvatore City Hospital, L'Aquila
Hambra Di Vitantonio

¹Department of Neurosurgery, San Salvatore City Hospital, L'Aquila
Valerio Di Norcia

¹Department of Neurosurgery, San Salvatore City Hospital, L'Aquila
Daniele Millimaggi

¹Department of Neurosurgery, San Salvatore City Hospital, L'Aquila
Alessandro Ricci

¹Department of Neurosurgery, San Salvatore City Hospital, L'Aquila
Renato Galzio

¹Department of Neurosurgery, San Salvatore City Hospital, L'Aquila

²Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila

Abstract

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

Full Text

References

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