Endoscopic-Assisted Microvascular Decompression of the Posterior Fossa: Early Experience in a Large Referral Center

Introduction : Along the past 40 years, thousands of patients have undergone microvascular decompression to treat vascular compression associated with trigeminal neuralgia and hemifacial spasm at our institution. Traditionally, the procedure is performed with the aid of the surgical microscope. In recent years, endoscopic techniques have been successfully applied in these procedures. The goal of this study is to report our initial experience with endoscopic microvascular decompression for vascular compression disorders of the posterior fossa. Methods : Retrospective review of our initial experience with endoscopic microvascular decompression for treatment of facial pain (trigeminal, genigulate and glossopharyngeal neuralgia) and hemifacial spasm. Technical aspects, operative findings, surgical outcome and complications were analyzed. Results : Between April 2012 and September 2013, 30 consecutive patients underwent an endoscopic-assisted retrosigmoid approach for the treatment of 16 trigeminal neuralgia, 10 hemifacial spasm, 3 geniculate neuralgia and 1 glossopharyngeal neuralgia. All patients were operated in a lateral position through a small retrosigmoid craniectomy. The superior cerebellar artery was the offending vessel in 10 patients, the anterior inferior cerebellar artery in seven, the posterior inferior cerebellar artery in seven and the vertebral artery in three. Venous pathology was noted in eleven patients. Excellent or good outcomes were seen in all but two patients. Regarding complications, there have been nine transient or permanent cranial nerve deficits, one vascular injury and one brainstem infarct. Conclusions : Endoscopic-assisted microvascular decompression is safe, effective and may be considered a valuable tool in the neurosurgeon's armamentarium for the treatment of vascular compression syndromes of the posterior fossa.