Microvascular decompression for neurovascular conflicts in the cerebello-pontine angle

Which role for endoscopy?

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background: Microvascular decompression (MVD) is the surgical intervention designed to resolve neurovascular conflicts (NCs) in the cerebellopontine angle (CPA). Today, endoscopy is commonly used in many neurosurgical procedures. This study aims to retrospectively assess the usefulness of endoscopy during MVD, focusing on microscopic endoscopic-assisted (MEA) MVD. Methods: Between January 2010 and December 2012, 141 patients underwent MVD procedures: 119 (84.5 %) were affected by idiopathic trigeminal neuralgia (TN), 20 (14 %) by hemifacial spasm (HFS), 1 by glossopharyngeal neuralgia (GN) and 1 by TN and GN simultaneously; 128 (91 %) MVD were first time procedures, while 13 (9 %) were recurrences (10 TN, 3 HFS). Visualization techniques used were: pure microscopic in 89 (63 %) cases, fully endoscopic in 12 (8.5 %) and MEA in 40 (28.5 %). The MEA technique was used when the conflict was not clearly identified under microscopic view or it was not certainly resolved. Results: Overall, a NC was found in 130 (92 %) cases, while 11 patients had no intraoperative evidence of NC. Considering specifically the 40 MEA cases, 12 (8.5 % overall) conflicts not clearly visible with the microscope were revealed and solved, a complete conflict resolution was confirmed in 13 (9 % overall) cases, while an incomplete conflict resolution was shown in four cases (3 % overall). Conclusion: Pure microscopic MVD remains the technique of choice. The endoscope is a useful adjunctive imaging tool in confirming NCs identified by the microscope, revealing conflicts missed by the microscopic survey alone and verifying adequate nerve decompression.

Original languageEnglish
Pages (from-to)1709-1716
Number of pages8
JournalActa Neurochirurgica
Volume155
Issue number9
DOIs
Publication statusPublished - Sep 2013

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Microvascular Decompression Surgery
Endoscopy
Trigeminal Neuralgia
Glossopharyngeal Nerve Diseases
Hemifacial Spasm
Negotiating
Neurosurgical Procedures
Cerebellopontine Angle
Endoscopes
Decompression
Conflict (Psychology)
Recurrence

Keywords

  • Endoscopy
  • Hemifacial spasm
  • Microvascular decompression
  • Retrosigmoid approach
  • Trigeminal neuralgia

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

@article{55a32db3fcb9452f8916393b545ced46,
title = "Microvascular decompression for neurovascular conflicts in the cerebello-pontine angle: Which role for endoscopy?",
abstract = "Background: Microvascular decompression (MVD) is the surgical intervention designed to resolve neurovascular conflicts (NCs) in the cerebellopontine angle (CPA). Today, endoscopy is commonly used in many neurosurgical procedures. This study aims to retrospectively assess the usefulness of endoscopy during MVD, focusing on microscopic endoscopic-assisted (MEA) MVD. Methods: Between January 2010 and December 2012, 141 patients underwent MVD procedures: 119 (84.5 {\%}) were affected by idiopathic trigeminal neuralgia (TN), 20 (14 {\%}) by hemifacial spasm (HFS), 1 by glossopharyngeal neuralgia (GN) and 1 by TN and GN simultaneously; 128 (91 {\%}) MVD were first time procedures, while 13 (9 {\%}) were recurrences (10 TN, 3 HFS). Visualization techniques used were: pure microscopic in 89 (63 {\%}) cases, fully endoscopic in 12 (8.5 {\%}) and MEA in 40 (28.5 {\%}). The MEA technique was used when the conflict was not clearly identified under microscopic view or it was not certainly resolved. Results: Overall, a NC was found in 130 (92 {\%}) cases, while 11 patients had no intraoperative evidence of NC. Considering specifically the 40 MEA cases, 12 (8.5 {\%} overall) conflicts not clearly visible with the microscope were revealed and solved, a complete conflict resolution was confirmed in 13 (9 {\%} overall) cases, while an incomplete conflict resolution was shown in four cases (3 {\%} overall). Conclusion: Pure microscopic MVD remains the technique of choice. The endoscope is a useful adjunctive imaging tool in confirming NCs identified by the microscope, revealing conflicts missed by the microscopic survey alone and verifying adequate nerve decompression.",
keywords = "Endoscopy, Hemifacial spasm, Microvascular decompression, Retrosigmoid approach, Trigeminal neuralgia",
author = "Morgan Broggi and Francesco Acerbi and Paolo Ferroli and Giovanni Tringali and Marco Schiariti and Giovanni Broggi",
year = "2013",
month = "9",
doi = "10.1007/s00701-013-1824-8",
language = "English",
volume = "155",
pages = "1709--1716",
journal = "Acta Neurochirurgica",
issn = "0001-6268",
publisher = "Springer Wien",
number = "9",

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TY - JOUR

T1 - Microvascular decompression for neurovascular conflicts in the cerebello-pontine angle

T2 - Which role for endoscopy?

AU - Broggi, Morgan

AU - Acerbi, Francesco

AU - Ferroli, Paolo

AU - Tringali, Giovanni

AU - Schiariti, Marco

AU - Broggi, Giovanni

PY - 2013/9

Y1 - 2013/9

N2 - Background: Microvascular decompression (MVD) is the surgical intervention designed to resolve neurovascular conflicts (NCs) in the cerebellopontine angle (CPA). Today, endoscopy is commonly used in many neurosurgical procedures. This study aims to retrospectively assess the usefulness of endoscopy during MVD, focusing on microscopic endoscopic-assisted (MEA) MVD. Methods: Between January 2010 and December 2012, 141 patients underwent MVD procedures: 119 (84.5 %) were affected by idiopathic trigeminal neuralgia (TN), 20 (14 %) by hemifacial spasm (HFS), 1 by glossopharyngeal neuralgia (GN) and 1 by TN and GN simultaneously; 128 (91 %) MVD were first time procedures, while 13 (9 %) were recurrences (10 TN, 3 HFS). Visualization techniques used were: pure microscopic in 89 (63 %) cases, fully endoscopic in 12 (8.5 %) and MEA in 40 (28.5 %). The MEA technique was used when the conflict was not clearly identified under microscopic view or it was not certainly resolved. Results: Overall, a NC was found in 130 (92 %) cases, while 11 patients had no intraoperative evidence of NC. Considering specifically the 40 MEA cases, 12 (8.5 % overall) conflicts not clearly visible with the microscope were revealed and solved, a complete conflict resolution was confirmed in 13 (9 % overall) cases, while an incomplete conflict resolution was shown in four cases (3 % overall). Conclusion: Pure microscopic MVD remains the technique of choice. The endoscope is a useful adjunctive imaging tool in confirming NCs identified by the microscope, revealing conflicts missed by the microscopic survey alone and verifying adequate nerve decompression.

AB - Background: Microvascular decompression (MVD) is the surgical intervention designed to resolve neurovascular conflicts (NCs) in the cerebellopontine angle (CPA). Today, endoscopy is commonly used in many neurosurgical procedures. This study aims to retrospectively assess the usefulness of endoscopy during MVD, focusing on microscopic endoscopic-assisted (MEA) MVD. Methods: Between January 2010 and December 2012, 141 patients underwent MVD procedures: 119 (84.5 %) were affected by idiopathic trigeminal neuralgia (TN), 20 (14 %) by hemifacial spasm (HFS), 1 by glossopharyngeal neuralgia (GN) and 1 by TN and GN simultaneously; 128 (91 %) MVD were first time procedures, while 13 (9 %) were recurrences (10 TN, 3 HFS). Visualization techniques used were: pure microscopic in 89 (63 %) cases, fully endoscopic in 12 (8.5 %) and MEA in 40 (28.5 %). The MEA technique was used when the conflict was not clearly identified under microscopic view or it was not certainly resolved. Results: Overall, a NC was found in 130 (92 %) cases, while 11 patients had no intraoperative evidence of NC. Considering specifically the 40 MEA cases, 12 (8.5 % overall) conflicts not clearly visible with the microscope were revealed and solved, a complete conflict resolution was confirmed in 13 (9 % overall) cases, while an incomplete conflict resolution was shown in four cases (3 % overall). Conclusion: Pure microscopic MVD remains the technique of choice. The endoscope is a useful adjunctive imaging tool in confirming NCs identified by the microscope, revealing conflicts missed by the microscopic survey alone and verifying adequate nerve decompression.

KW - Endoscopy

KW - Hemifacial spasm

KW - Microvascular decompression

KW - Retrosigmoid approach

KW - Trigeminal neuralgia

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DO - 10.1007/s00701-013-1824-8

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JO - Acta Neurochirurgica

JF - Acta Neurochirurgica

SN - 0001-6268

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