Endoscope Assisted Microvascular Decompression for Trigeminal Neuralgia: Surgical Safety and Efficacy

Karadag, Ali; Mirkhasilova, Muyassar; Turkis, Omer Furkan; Yuncu, Mustafa Eren; Grande, Andrew W.; Lopez, Gilberto Gonzalez; Roser, Florian; Tatagiba, Marcos

doi:10.14712/18059694.2024.14

Acta Medica > Archive > 2024, Vol. 67 > Issue 1 > Endoscope Assisted Microvascular…

Acta Med. 2024, 67: 12-20

https://doi.org/10.14712/18059694.2024.14

Endoscope Assisted Microvascular Decompression for Trigeminal Neuralgia: Surgical Safety and Efficacy

Ali Karadag^a,b, Muyassar Mirkhasilova^c, Omer Furkan Turkis^d, Mustafa Eren Yuncu^e, Andrew W. Grande^c, Gilberto Gonzalez Lopez^f, Florian Roser^g, Marcos Tatagiba^h

^aIzmir City Hospital, Department of Neurosurgery, Izmir, Turkey
^bUniversity of Health Sciences, Izmir Faculty of Medicine, Department of Neurosurgery, Izmir, Turkey
^cUniversity of Minnesota, Department of Neurosurgery Neuroanatomy Laboratory, Minnesota, USA
^dAntalya Ataturk State Hospital, Department of Neurosurgery, Antalya, Turkey
^eElbistan State Hospital, Department of Neurosurgery, Kahramanmaras, Turkey
^fUniversity Hospital San Juan de Dios, Department of Neurosurgery, Armenia-Quindio, Colombia
^gCleveland Clinic Abu Dhabi, Neurological Institute, Department of Neurosurgery, Abu Dhabi, UAE
^hEberhard Karls University of Tübingen, Department of Neurosurgery, Tubingen, Germany

Received April 11, 2023
Accepted February 26, 2024

Background: The cranial nerve (CN) V and adjacent neurovascular structures are crucial landmarks in microvascular decompression (MVD). MVD of CN V is the most effective treatment for patients with drug-resistant trigeminal neuralgia (TN) diagnosis. The endoscope-assisted retrosigmoid approach (RSA) provides better exposure and less cerebellar retraction in the corridor towards the cerebellopontine angle (CPA). Methods: Five adult cadaver heads (10 sides) underwent dissection of the MVD in park bench position. MVD was simulated using microsurgical RSA, and the anatomical landmarks were defined. Microsurgical dissections were additionally performed along the endoscopic surgical path. Additionally, we present an illustrative case with TN caused by anterior inferior cerebellar artery (AICA) compression. The CN V and its close relationships were demonstrated. Endoscopic and microscopic three-dimensional pictures were obtained. Results: This study increases the anatomical and surgical orientation for CN V and surrounding structures. The CN V arises from the lateral part of the pons and runs obliquely upward toward the petrous apex. It has motor roots that leave from pons antero-supero-medial direction to the sensory root. The endoscopic instruments provide perfect visualization with minimal cerebellar retraction during MVD. Conclusion: MVD surgically targets the offending vessel(s) leading to TN and aims to create a disconnected area. The combination of preoperative radiographic assessment with and anatomical correlation provides safe and effective application while facilitating selection of the most appropriate approach. The RSA allows satisfactory visualization for CN V. Endoscope-assisted microsurgery through the CPA is a challenge, it should be performed with advanced anatomical knowledge.