I did some research on behalf of one of our members, and thought I would cross-post here in the MVD group. The following are abstracts of reports on the effectiveness of MVD done with an endoscope. I will post a few more in the discussion.
Endoscopic Microvascular Decompression: A Stepwise Operative Technique.
Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pa., USA.
Background/Aims: Microvascular decompression (MVD) of the trigeminal nerve is a widely accepted treatment for patients with trigeminal neuralgia caused by vascular compression. The neuroendoscope is rapidly becoming a complementary tool in minimally invasive neurosurgery of the ventral anterior skull base. Its adoption in the lateral approach to the posterior fossa has been slower and has been used primarily as an adjunct to conventional microscopic surgical techniques, e.g. endoscope-assisted microsurgery. Methods: In this paper, we describe a stepwise, technical commentary on a purely endoscopic MVD of the trigeminal nerve via the retrosigmoid route. Results: From our experience, the endoscope provides excellent visualization of the neurovascular relationship. By allowing full visualization of the trigeminal nerve, endoscopy may likely lead to an increase in the number of successful MVDs and a decrease in the number of complications. Conclusion: We believe endoscopic MVD is a safe and effective method of accessing the trigeminal nerve in the cerebellopontine angle and of performing MVD. This endoscopic technique can be implemented in other neurosurgical and neuro-otological procedures such as resection of cerebellopontine angle masses.
Copyright © 2012 S. Karger AG, Basel.
[Endoscopic assistance in microvascular decompression of cranial nerves].
[Article in Russian]
Microvascular decompression (MVD) is an effective method for treatment of trigeminal neuralgia (TN), hemifacial spasm (HFS), glossopharyngeal neuralgia (GPN). The aim of this study was to assess the role of endoscopic assistance in MVD for the treatment of cranial neuropathies. Since 2009 till 2011 133 patients with cranial neuropathies were treated by MVD in Burdenko Neurosurgical Institute, Moscow. In 22 patients (11 patients with HFS, 10 patients with TN, 1 with GPN) endoscopic assistance was applied during the MVD. We used minimally invasive retrosigmoid approach in a unilateral position. Cerebellopontine angle was explored by 30-degree or 70-degree telescope to visualize the root entry zone of trigeminal, facial or glossopharyngeal nerves and to locate the neurovascular conflict. In 9 patients with HFS and in 1 patient with TN and in another patient with GPN endoscopy discovered offending vessels that were not visible through the microscope. In all cases endoscope was used to exclude another site of compression and to verify decompression and to identify position of teflon and offending vessel after MVD. Immediately after the surgery excellent outcome was observed in 10 patients with HFS (89%), one patient was reoperated 1.5 years after first operation with positive effect. Relief of pain in early postoperative period was observed in patients with TN and GPN. There were no major complications and postoperative mortality in our series. Endoscopic assistance is very effective and helpful technique in MVD of cranial nerves, especially in cases with HFS. In this study the use of the endoscope allowed to identify the site of compression and to confirm the position of teflon after MVD.
- [PubMed - indexed for MEDLINE]
The following abstract suggests that endoscopic examination during MVD has definite advantages over a microscope.
Endoscopic neurovascular perspective in microvascular decompression of trigeminal neuralgia.
Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China.
To evaluate the advantages of endoscopic assistance in microvascular decompression (MVD) for the treatment of trigeminal neuralgia (TGN).
One hundred and sixty-seven patients suffering from TGN were treated by MVD from October 2003 to December 2006. The operating microscope was used in conjunction with a 30 degrees effect endoscope to diagnose neurovascular compression (NVC).
The type and grade of NVC were determined in all cases. 85.26% of neurovascular conflicts were diagnosed with the microscope alone. An additional 14.76% could be diagnosed with the assistance of the endoscope. 96.79% of patients experienced immediate relief of pain.
MVD is a highly effective treatment for TGN. Endoscopes are very useful during the procedures. They increase the clarity of the surgical field and they enable panoramic visualization in areas that are blind to the direct field of view of the operating microscope. A significant percentage of neurovascular conflicts would be missed at surgery without endoscopic assistance.
- [PubMed - indexed for MEDLINE]
And last but not least...
Endoscopic vascular decompression versus microvascular decompression of the trigeminal nerve.
Skull Base Institute, Los Angeles, CA 90048, USA.
Microvascular decompression (MVD) is a highly accepted and effective method for treatment of patients with trigeminal neuralgia in whom compression of the nerve by a vascular structure is implicated in the pathogenesis of the disease. However, recent reports have highlighted the advantages of the endoscope in visualizing structures within the cerebellopontine angle. Additional research, using the endoscope to supplement the microscopic procedure, has demonstrated improved localization of neurovascular conflicts. In this report we present the results of our series utilizing a fully endoscopic vascular decompression (EVD) technique, and compare these results to those published for microvascular decompression. From September 1999 until October 2004, 255 patients underwent endoscopic vascular decompression of the trigeminal nerve. These patients' records were retrospectively reviewed, and additional data from follow-up visits were collected and analyzed to ascertain success rates and review the incidence of complications. From a total of 255 patients who underwent EVD of the trigeminal nerve we noted an initial, complete, postoperative success rate in 95 % of patients. Initial, being defined as within the first 3 months postoperative, and "complete" being judged if the patient reported 98 % relief of pain postoperatively without the need for medication (Barker's classification). Additionally, we documented a 93 % complete success rate for 118 patients who completed at least a three-year follow-up period. Complication rates were compared to those reported for MVD. There were no serious complications or mortality in this series. We conclude that EVD is a safe and effective method to remove neurovascular conflicts related to the trigeminal nerve. The results of this series demonstrate an improved rate of trigeminal neuralgia relief with EVD when compared to MVD, a lower incidence of complications and a better outcome.
- [PubMed - indexed for MEDLINE]
Those are great, thanks for sharing!
I had keyhole/endoscopic MVD last June after 4 years of type1 TN. I have been free of the horrific electric shock pain since I came out of anesthesia. My incision was much smaller than the pictures of traditional MVD I have seen posted on this forum. Opening to my skull was dime size in diameter and it was closed without staples..it was more of a super glue type substance for lack of a better term. I would be happy to answer questions. This surgery gave me my life back!
Where did you go to have this surgery done? I have type 1&2, and I am almost at the end of my rope. My doctor set me up to see Dr. Mollie Johnston at UCLA, but I have since read here that she doesn’t specialize in TN or MVD procedures. I just don’t have it in me to waste any more time in a doctor’s office if she doesn’t have the knowledge and skills to fix my problem. I own a conservatory of music, and this disease is robbing me of my music, my life, and my passion to teach. I want to have the micro vascular decompression surgery like you did, and I need a doctor who will listen to me and take me seriously instead of treating me like a middle aged woman who is “overly sensitive”!
I had keyhole/endoscopic MVD last June after 4 years of type1 TN. I have been free of the horrific electric shock pain since I came out of anesthesia. My incision was much smaller than the pictures of traditional MVD I have seen posted on this forum. Opening to my skull was dime size in diameter and it was closed without staples…it was more of a super glue type substance for lack of a better term. I would be happy to answer questions. This surgery gave me my life back!
You might investigate Dr. Mark Linskey at UC Irvine. He has an excellent reputation as a neurosurgeon specialist in facial pain and TN
I understand Dr melvin Field in Orlando does this too. Any comments on his success rates?