gms | German Medical Science

Objective: This prospective clinical study was conducted to evaluate the feasibility and clinical implication of sole endoscopic decompression of the trigeminal nerve for neuralgia. Primary endpoints were visualization of the trigeminal nerve, perioperative complications, and shot-term outcome of the patients.

Method: Between March 2011 and May 2012 five patients (three women, two, men; mean age 57.2 years) with refractory trigeminal neuralgia underwent microvascular decompression (MVD) according to Jannetta in endoscopic technique. 2D HD optical systems (Hopkins II and Lotta, Storz Incorp.)) were employed with microsurgical instruments including flexible memory tools (L-Line memory, P Lazic GmbH) to resolve the nerve-vessel-conflict intraoperatively. Additionally, 3D optical system (Visionsense^®) was simultaneously used to evaluate possible advantages of a three-dimensional resolution.

Results: Stand-alone endoscopic decompression of the trigeminal nerve could be carried out in all patients in prone position via a small retrosigmoidal supracerebellar approach. A nerve-vessel-conflict was released in all cases. Visualization was excellent with 2D HD optics, and 3D optical system additionally improved resolution of the anatomy. There were no intraoperative complications. Postoperatively, one patient reported a transient hypoesthesia in V2/3. In another case a vestibular neuritis was treated conservatively. Same patient also developed a superficial wound infection requiring oral antibiotics. All patients reported substantial relief of pain immediately after operation. Four of them were able to discontinue their prophylactic medication. After six months, two patients suffered from a relapse and underwent re-operation (microsurgically) with intermediate success.

Conclusions: Stand-alone endoscopic microvascular decompression is feasible with enhanced visualization of the upper cranial nerves, the conflicting vessels and the ambient cistern. In our series, there was no intraoperative complication and minor transient morbidity in two cases, only. Larger series are required to analyze the value of endoscopic MVD compared to traditional technique. 3D resolution has to be further evaluated for its beneficial help.