Vascular Decompression of Trigeminal and Facial Nerves in the Posterior Fossa under Endoscope-Assisted Keyhole Conditions

ABSTRACT

Objective: The aim of this study was to determine the use and safety of the endoscope as an adjunct during trigeminal and facial nerve decompression procedures performed under keyhole conditions in the posterior fossa. Method: We performed 67 surgeries in 65 patients with symptomatic trigeminal and facial nerve compression syndromes. The diagnosis was made mainly on the basis of clinical history, examination, and magnetic resonance imaging scans. Surgery was performed in all cases under endoscope-assisted keyhole conditions. The follow-up was 1 week postoperatively, 6 months, and then yearly up to 7 years. All 34 patients with trigeminal neuralgia received preoperative medication treatment and experienced failure with it. Eighteen patients out of 30 with hemifacial spasm had been previously treated with botulinum toxin injections. One patient suffered from both trigeminal neuralgia and facial spasm, because of a megadolichobasilar and vertebral artery with compression of both cranial nerves. Results: Sixty-four of the 65 patients became symptom free after surgical treatment; one revision surgery was necessary because of disappearance of the decompression muscle piece. No mortalities or minor morbidities were observed in this series. Conclusion: A precise planned keyhole craniotomy and the simultaneous use of the microscope and the endoscope render the procedure of the decompression less traumatic.

KEYWORDS

Trigeminal neuralgia - hemifacial spasm - endoscope-assisted neurosurgery - neurovascular compression syndromes

REFERENCES

• 1 Jannetta P J. Gross (mesoscopic) description of the human trigeminal nerve and ganglion.  J Neurosurg. 1967;  26(suppl) 109-111
• 2 Payner T D, Tew Jr J M. Recurrence of hemifacial spasm after microvascular decompression.  Neurosurgery. 1996;  38 686-690 discussion 690-691
• 3 Resnick D K, Jannetta P J, Bissonnette D, Jho H D, Lanzino G. Microvascular decompression for glossopharyngeal neuralgia.  Neurosurgery. 1995;  36 64-68 discussion 68-69
• 4 Jannetta P J. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia.  J Neurosurg. 1967;  26(suppl) 159-162
• 5 Barker II F G, Jannetta P J, Bissonette D J, Larkins M V, Jho H D. The long-term outcome of microvascular decompression for trigeminal neuralgia.  N Engl J Med. 1996;  334 1077-1083
• 6 McLaughlin M R, Jannetta P J, Clyde B L, Subach B R, Comey C H, Resnick D K. Microvascular decompression of cranial nerves: lessons learned after 4400 operations.  J Neurosurg. 1999;  90 1-8
• 7 Bederson J B, Wilson C B. Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia.  J Neurosurg. 1989;  71 359-367
• 8 Cutbush K, Atkinson R L. Treatment of trigeminal neuralgia by posterior fossa microvascular decompression.  Aust N Z J Surg. 1994;  64 173-176
• 9 Lovely T J, Jannetta P J. Microvascular decompression for trigeminal neuralgia: surgical technique and long-term results.  Neurosurg Clin N Am. 1997;  8 11-29
• 10 Aksik I. Microneural decompression operations in the treatment of some forms of cranial rhizopathy.  Acta Neurochir (Wien). 1993;  125 64-74
• 11 Hanakita J, Kondo A. Serious complications of microvascular decompression operations for trigeminal neuralgia and hemifacial spasm.  Neurosurgery. 1988;  22 348-352
• 12 Kureshi S A, Wilkins R H. Posterior fossa reexploration for persistent or recurrent trigeminal neuralgia or hemifacial spasm: surgical findings and therapeutic implications.  Neurosurgery. 1998;  43 1111-1117
• 13 Lee S H, Levy E I, Scarrow A M, Kassam A, Jannetta P J. Recurrent trigeminal neuralgia attributable to veins after microvascular decompression.  Neurosurgery. 2000;  46 356-361 discussion 361-362
• 14 Liao J J, Cheng W C, Chang C N et al.. Reoperation for recurrent trigeminal neuralgia after microvascular decompression.  Surg Neurol. 1997;  47 562-568 discussion 568-570
• 15 Rath S A, Klein H J, Richter H P. Findings and long-term results of subsequent operations after failed microvascular decompression for trigeminal neuralgia.  Neurosurgery. 1996;  39 933-938 discussion 938-940
• 16 Perneczky A, Fries G. Endoscope-assisted brain surgery: part 1-evolution, basic concept, and current technique.  Neurosurgery. 1998;  42 219-224 discussion 224-225
• 17 Charalampaki P, Filippi R, Welschehold S, Conrad J, Perneczky A. Tumors of the lateral and third ventricle: removal under endoscope-assisted keyhole conditions.  Neurosurgery. 2005;  57 302-311 discussion 302-311
• 18 Badr-El-Dine M, El-Garem H F, Talaat A M, Magnan J. Endoscopically assisted minimally invasive microvascular decompression of hemifacial spasm.  Otol Neurotol. 2002;  23 122-128
• 19 El-Garem H F, Badr-El-Dine M, Talaat A M, Magnan J. Endoscopy as a tool in minimally invasive trigeminal neuralgia surgery.  Otol Neurotol. 2002;  23 132-135
• 20 Kabil M S, Eby J B, Shahinian H K. Endoscopic vascular decompression versus microvascular decompression of the trigeminal nerve.  Minim Invasive Neurosurg. 2005;  48 207-212
• 21 King W A, Wackym P A, Sen C, Meyer G A, Shiau J, Deutsch H. Adjunctive use of endoscopy during posterior fossa surgery to treat cranial neuropathies.  Neurosurgery. 2001;  49 108-115 discussion 115-116
• 22 Fries G, Perneczky A. Endoscope-assisted brain surgery: part 2-analysis of 380 procedures.  Neurosurgery. 1998;  42 226-231 discussion 231-232
• 23 Kalkanis S N, Eskandar E N, Carter B S, Barker II F G. Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes.  Neurosurgery. 2003;  52 1251-1261 discussion 1261-1262
• 24 Kaye A H, Adams C B. Hemifacial spasm: a long-term follow-up of patients treated by posterior fossa surgery and facial nerve wrapping.  J Neurol Neurosurg Psychiatry. 1981;  44 1100-1103