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
P. CharalampakiM.D.
Department of Neurosurgery, Johannes Gutenberg University
55131 Mainz, Germany
eMail: charalampaki@yahoo.de
