Abstract
OBJECTIVE: To discuss the results of endoscope-assisted surgery in microvascular decompression (MVD) of Cranial Nerves (CNs) V, VII, and VIII. METHODS: Neuroendoscopy was used as an adjunct to the surgical microscope in the MVD of the trigeminal (17 patients), facial (10 patients), and vestibulocochlear (1 patient) nerves in a series of 28 consecutive patients. After a standard microsurgical approach to CNs V, VII, and VIII, the endoscope was used to inspect all aspects of neural anatomy, to assess vascular compression, and to check the results of the decompression. Endoscope use was graded in four categories: Grade I, used but no definite role; Grade II, visualization assisted; Grade III, procedure assisted; and Grade IV, primary role. The usefulness of the endoscope was evaluated in each case. RESULTS: The endoscope was useful in visualizing the anatomy in all cases. It was especially useful in establishing trigeminal vein compression of CN V in Meckel's cave; observing multiple sources of vascular compression; ensuring adequate decompression after cauterization of vein, insertion of the Teflon felt, or a pexy procedure; and permitting observation of the compression of CN VII at the root exit zone by small arteries and veins. In six patients with trigeminal neuralgia, the trigeminal vein was cauterized and divided by using endoscopic vision only because the venous compression was not completely visualized with the microscope. During a follow-up period of 6 to 52 months (mean, 29 mo; median, 40 mo), all patients were asymptomatic and receiving no medication. CONCLUSION: The endoscope is a useful adjunct to MVD in the treatment of trigeminal neuralgia, hemifacial spasm, and disabling positional vertigo or tinnitus.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 876-883 |
| Number of pages | 8 |
| Journal | Neurosurgery |
| Volume | 54 |
| Issue number | 4 |
| State | Published - Apr 2004 |
| Externally published | Yes |
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Keywords
- Disabling positional vertigo or tinnitus
- Hemifacial spasm
- Microvascular decompression
- Neuroendoscope
- Trigeminal neuralgia
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
Cite this
Endoscope-assisted Microsurgery for Microvascular Compression Syndromes. / Rak, Ramin; Sekhar, Laligam N.; Stimac, Dinko; Hechl, Peter; Cohen, Alan; Perneczky, Axel; Reisch, Robert; Bertalanffy, Helmut; Hellwig, Dieter; Brisman, Ronald.
In: Neurosurgery, Vol. 54, No. 4, 04.2004, p. 876-883.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Endoscope-assisted Microsurgery for Microvascular Compression Syndromes
AU - Rak, Ramin
AU - Sekhar, Laligam N.
AU - Stimac, Dinko
AU - Hechl, Peter
AU - Cohen, Alan
AU - Perneczky, Axel
AU - Reisch, Robert
AU - Bertalanffy, Helmut
AU - Hellwig, Dieter
AU - Brisman, Ronald
PY - 2004/4
Y1 - 2004/4
N2 - OBJECTIVE: To discuss the results of endoscope-assisted surgery in microvascular decompression (MVD) of Cranial Nerves (CNs) V, VII, and VIII. METHODS: Neuroendoscopy was used as an adjunct to the surgical microscope in the MVD of the trigeminal (17 patients), facial (10 patients), and vestibulocochlear (1 patient) nerves in a series of 28 consecutive patients. After a standard microsurgical approach to CNs V, VII, and VIII, the endoscope was used to inspect all aspects of neural anatomy, to assess vascular compression, and to check the results of the decompression. Endoscope use was graded in four categories: Grade I, used but no definite role; Grade II, visualization assisted; Grade III, procedure assisted; and Grade IV, primary role. The usefulness of the endoscope was evaluated in each case. RESULTS: The endoscope was useful in visualizing the anatomy in all cases. It was especially useful in establishing trigeminal vein compression of CN V in Meckel's cave; observing multiple sources of vascular compression; ensuring adequate decompression after cauterization of vein, insertion of the Teflon felt, or a pexy procedure; and permitting observation of the compression of CN VII at the root exit zone by small arteries and veins. In six patients with trigeminal neuralgia, the trigeminal vein was cauterized and divided by using endoscopic vision only because the venous compression was not completely visualized with the microscope. During a follow-up period of 6 to 52 months (mean, 29 mo; median, 40 mo), all patients were asymptomatic and receiving no medication. CONCLUSION: The endoscope is a useful adjunct to MVD in the treatment of trigeminal neuralgia, hemifacial spasm, and disabling positional vertigo or tinnitus.
AB - OBJECTIVE: To discuss the results of endoscope-assisted surgery in microvascular decompression (MVD) of Cranial Nerves (CNs) V, VII, and VIII. METHODS: Neuroendoscopy was used as an adjunct to the surgical microscope in the MVD of the trigeminal (17 patients), facial (10 patients), and vestibulocochlear (1 patient) nerves in a series of 28 consecutive patients. After a standard microsurgical approach to CNs V, VII, and VIII, the endoscope was used to inspect all aspects of neural anatomy, to assess vascular compression, and to check the results of the decompression. Endoscope use was graded in four categories: Grade I, used but no definite role; Grade II, visualization assisted; Grade III, procedure assisted; and Grade IV, primary role. The usefulness of the endoscope was evaluated in each case. RESULTS: The endoscope was useful in visualizing the anatomy in all cases. It was especially useful in establishing trigeminal vein compression of CN V in Meckel's cave; observing multiple sources of vascular compression; ensuring adequate decompression after cauterization of vein, insertion of the Teflon felt, or a pexy procedure; and permitting observation of the compression of CN VII at the root exit zone by small arteries and veins. In six patients with trigeminal neuralgia, the trigeminal vein was cauterized and divided by using endoscopic vision only because the venous compression was not completely visualized with the microscope. During a follow-up period of 6 to 52 months (mean, 29 mo; median, 40 mo), all patients were asymptomatic and receiving no medication. CONCLUSION: The endoscope is a useful adjunct to MVD in the treatment of trigeminal neuralgia, hemifacial spasm, and disabling positional vertigo or tinnitus.
KW - Disabling positional vertigo or tinnitus
KW - Hemifacial spasm
KW - Microvascular decompression
KW - Neuroendoscope
KW - Trigeminal neuralgia
UR - http://www.scopus.com/inward/record.url?scp=12144288808&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=12144288808&partnerID=8YFLogxK
M3 - Article
C2 - 15046653
AN - SCOPUS:12144288808
VL - 54
SP - 876
EP - 883
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 4
ER -