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Preoperative findings in relation to the usefulness of endoscopic assistance for microvascular decompression

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Abstract

Purpose

Endoscopy is known to be a useful adjunct for microvascular decompression (MVD) surgery, assisting observation in blind spots such as Meckel’s cave in cases of trigeminal neuralgia (TN) and the root exit zone (REZ) in hemifacial spasm (HFS). However, few reports have discussed the usefulness of endoscopy in relation to individual patient characteristics or preoperative magnetic resonance imaging (MRI).

Methods

We retrospectively reviewed the medical records of 109 patients (98 with HFS and 11 with TN, 85 women, median age 55 years) who had undergone endoscopically assisted MVD at our institution between 2017 and 2021. The usefulness of endoscopy in individual cases was scored by three neurosurgeons using a grading scale: 2, essential and indispensable; 1, useful and helpful; 0, not necessary. The mean value of the assigned scores was taken as an indicator of “usefulness,” and endoscopy was considered to have been “useful” in cases with a score of > 1.0.

Results

Endoscopic assistance was judged to have been useful in 69% of the patients. The proportion of patients evaluated as useful was significantly lower for TN (18.2%) than for HFS (74.5%). Patients with superior cerebellar artery compression had significantly lower scores than patients with other vessels. Endoscopy was considered useful in a significantly higher proportion of patients with anatomically complicated offending vessels (bifurcation or strong meandering) in the REZ detected by preoperative MRI (P < 0.005).

Conclusion

Endoscopy for MVD is useful for patients with HFS, especially when preoperative MRI shows bifurcation or strongly meandering vessels in the REZ.

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Abbreviations

AICA:

Anterior inferior cerebellar artery

HFS:

Hemifacial spasm

MRI:

Magnetic resonance imaging

MVD:

Microvascular decompression

PICA:

Posterior inferior cerebellar artery

REZ:

Root exit zone

SCA:

Superior cerebellar artery

TN:

Trigeminal neuralgia

VA:

Vertebral artery

References

  1. Abdeen K, Kato Y, Kiya N, Yoshida K, Kanno T (2000) Neuroendoscopy in microvascular decompression for trigeminal neuralgia and hemifacial spasm: technical note. Neurol Res 22(5):522–526

    Article  CAS  PubMed  Google Scholar 

  2. Cai Q, Li Z, Guo Q, Wang W, Ji B, Chen Z et al (2021) Microvascular decompression using a fully transcranial neuroendoscopic approach. Br J Neurosurg 25:1–4

    Google Scholar 

  3. Flanders TM, Blue R, Roberts S, McShane BJ, Wilent B, Tambi V, Petrov D, Lee JYK (2018) Fully endoscopic microvascular decompression for hemifacial spasm. J Neurosurg 131:813–819

    Article  PubMed  Google Scholar 

  4. Fujimaki T, Kirino T (2000) Combined transhorizontal-supracerebellar approach for microvascular decompression of trigeminal neuralgia. Br J Neurosurg 14(6):531–534

    Article  CAS  PubMed  Google Scholar 

  5. Fukuda H, Ishikawa M, Okumura R (2003) Demonstration of neurovascular compression in trigeminal neuralgia and hemifacial spasm with magnetic resonance imaging: comparison with surgical findings in 60 consecutive cases. Surg Neurol 59(2):93–9 (discussion 99-100)

    Article  PubMed  Google Scholar 

  6. Jarrahy R, Berci G, Shahinian HK (2000) Endoscope-assisted microvascular decompression of the trigeminal nerve. Otolaryngol Head Neck Surg 123(3):218–223

    Article  CAS  PubMed  Google Scholar 

  7. Li Y, Mao F, Cheng F, Peng C, Guo D, Wang B (2019) A meta-analysis of endoscopic microvascular decompression versus microscopic microvascular decompression for the treatment for cranial nerve syndrome caused by vascular compression. World Neurosurg 126:647-655.e7

    Article  PubMed  Google Scholar 

  8. Mizobuchi Y, Nagashiro S, Akinori K, Arita K, Date I, Fujii Y, Fujimaki T et al (2021) Prospective, multicenter clinical study of microvascular decompression for hemifacial spasm. Neurosurgery 88(4):846–854

    Article  PubMed  Google Scholar 

  9. Mizobuchi Y, Nagashiro S, Akinori K, Arita K, Date I, Fujii Y, Fujimaki T et al. (2021) Microvascular decompression for trigeminal neuralgia: a prospective, multicenter study. 89(4):557–564

  10. Ohta M, Kobayashi M, Wakiya K, Takamizawa S, Niitsu M, Fujimaki T (2014) Preoperative assessment of hemifacial spasm by the coronal heavily T2-weighted MR cisternography. Acta Neurochir (Wien) 156:565–569

    Article  PubMed  Google Scholar 

  11. Rak R, Sekhar LN, Stimac D, Hechl P (2004) Endoscope-assisted microsurgery for microvascular compression syndromes. Neurosurgery 54(4):876–81 (discussion 881-3)

    Article  PubMed  Google Scholar 

  12. Refaee EE, Fleck S, Matthes M, Marx S, Baldauf J, Schroeder HWS (2021) Outcome of endoscope-assisted microvascular decompression in patients with hemifacial spasm caused by severe indentation of the brain stem at the pontomedullary sulcus by the posterior inferior cerebellar artery. Oper Neurosurg (Hagerstown) 20(6):E399–E405

    Article  PubMed  Google Scholar 

  13. 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 (discussion 1909)

    Article  PubMed  Google Scholar 

  14. Son BC, Ko HC, Choi JG (2018) Intraoperative monitoring of Z-L response (ZLR) and abnormal muscle response (AMR) during microvascular decompression for hemifacial spasm. Interpreting the role of ZLR. Acta Neurochir (Wien) 160(5):963–970

    Article  PubMed  Google Scholar 

  15. Teo C, Nakaji P, Mobbs R J (2006) Endoscope-assisted microvascular decompression for trigeminal neuralgia: technical case report. Neurosurgery 59(4 Suppl 2):ONSE 489–90

  16. Thirumala PD, Altibi AM, Chang R, Saca EE, Lyengar P, Reddy R, Anetakis K et al (2020) The utility of intraoperative lateral spread recording in microvascular decompression for hemifacial spasm: a systematic review and meta-analysis. Neurosurgery 87(4):E473-484

    Article  PubMed  Google Scholar 

  17. Zheng X, Hong W, Tang Y et al (2012) Discovery of a new waveform for intraoperative monitoring of hemifacial spasms. Acta Neurochir (Wien) 154(5):799–805

    Article  PubMed  Google Scholar 

  18. Zhi M, Lu XJ, Wang Q, Li B (2017) Application of neuroendoscopy in the surgical treatment of complicated hemifacial spasm. Neurosciences (Riyadh) 22(1):25–30

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Saitama Medical University Hospital, 38 Morohongo, Moroyama-Machi, Iruma-Gun, Saitama, 350-0495, Japan

    Sachiko Hirata, Masahito Kobayashi, Masaki Ujihara, Kazuhiko Takabatake & Takamitsu Fujimaki

Authors
  1. Sachiko Hirata
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  2. Masahito Kobayashi
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  3. Masaki Ujihara
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  4. Kazuhiko Takabatake
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  5. Takamitsu Fujimaki
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Corresponding author

Correspondence to Sachiko Hirata.

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Ethics approval

This study was approved by the institutional review board, and written informed consent was waived because of the retrospective design. Ethical approval was waived by the local Ethics Committee of Saitama Medical University Hospital in view of the retrospective nature of the study, and all the procedures being performed were part of the routine care.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Hirata, S., Kobayashi, M., Ujihara, M. et al. Preoperative findings in relation to the usefulness of endoscopic assistance for microvascular decompression. Acta Neurochir 165, 3011–3017 (2023). https://doi.org/10.1007/s00701-023-05762-9

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  • DOI: https://doi.org/10.1007/s00701-023-05762-9

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