Neurological Surgery Resident University of Texas Southwestern Dallas, Texas, United States
Introduction: Microvascular decompression is an effective treatment for trigeminal neuralgia and hemifacial spasm. Minimally invasive approaches to MVD are thought to minimize the surgical footprint without compromising the goal of surgery. The objective of this study was to characterize the outcomes of a single-center multi-surgeon series of microvascular decompression performed utilizing minimally invasive principles.
Methods: All consecutive patients undergoing MVD between 1/1/2020 and 7/31/2022 were retrospectively reviewed. Baseline characteristics including BNI pain score were collected. Craniotomy size was measured on the postoperative CT. The use of endoscopy was determined. Primary outcome measure was the BNI pain score at last follow up.
Results: Thirty-two patients were included (TN I: 23, hemifacial spasm: 5). Median age was 70.1. The endoscope was used for the entire microdissection in 14 (43.8%) cases and as an adjunct in 15 (46.9%) cases. The median craniotomy size was 18mm in diameter (IQR: 5mm). Simple padding was performed in 13 (40.6%) cases while mobilization of the entire segment of the offending vessel was achieved in 18 (56.3%) cases. In 1 case, a CPA cyst was resected endoscopically. BNI scores of I and II were achieved in 21 (65.6%) and 7 (21.9%) patients respectively, in comparison to preoperative scores of IV and V in 26 (81.3%) and 2 (6.3%) patients respectively.
Conclusion : Minimally invasive approaches for microvascular decompression, including the use of endoscopy, can produce successful neurovascular decompression with good reduction in pain and a decrease in medication dependency.
