We report microvascular decompression (MVD) under neuroendoscopic view in hemifacial spasm (HFS) patients with rostral- and perforator-type compression of the root exit zone (REZ) of the facial nerve. Using either a wireless iPad Mini as a monitor on the microscope or a high-resolution monitor, microscopic and endoscopic views enabled MVD for complete cure of HFS with rostral-type compression (the offender compressing the REZ on the opposite rostral side to the operative approach) or perforator-type compression (the offender tethered to the REZ by the perforator). MVD under neuroendoscopic view may offer more accurate MVD and complete resolution of HFS.
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Conflict of interest
The role of endoscopy in microvascular decompression (MVD) is currently not well defined. Visualization of neurovascular conflicts at the level of the CPA is a key factor for a satisfactory outcome of the procedure whether the procedure is done for HFS, TGN, or other conditions.
Traditional approaches are based on a standard exposure of the CPA with CFS release and visualization of the upper, middle, or lower CPA complex (depending on the indication for the MVD).
At times, the compression is "around the corner" and endoscopic instruments allow a better visualization of the conflict, as the authors have clearly described in this article. There are still limitations of the technique, mainly in relation to the limited anatomical space and the complexity of the surgical anatomy. Endoscopy is a useful adjunction to the surgical "armamentarium" of neurosurgeons performing MVD.
Jibril Osman Farah
Sandell T, Ringstad GA, Eide PK (2014)Usefulness of the endoscope in microvascular decompression for trigeminal neuralgia and MRI-based prediction of the need for endoscopy. Acta Neurochir (Wien) 156(10):1901-9
Setty P, Volkov AA, D'Andrea KP, Pieper DR (2014) Endoscopic vascular decompression for the treatment of trigeminal neuralgia: clinical outcomes and technical note. World Neurosurg 81(3-4):603-8.
The authors have no personal or institutional interest in any of the drugs, materials, or devices described in this article.
Electronic supplementary material
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The author performing the operation under microscopic and neuroendoscopic views with the wireless iPad Mini monitor on the microscope. (video) (WMV 14.2 MB)
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Ishikawa, M., Tanaka, Y. & Watanabe, E. Microvascular decompression under neuroendoscopic view in hemifacial spasm: rostral-type compression and perforator-type compression. Acta Neurochir 157, 329–332 (2015). https://doi.org/10.1007/s00701-014-2294-3
- Hemifacial spasm
- Microvascular decompression