title: Fully endoscopic vascular decompression of the glossopharyngeal nerve.
abstract: Microvascular decompression of the glossopharyngeal nerve is an effective treatment of patients with glossopharyngeal neuralgia in whom compression of the nerve by a blood vessel is implicated in the pathogenesis of the disease. The standard surgical technique uses a binocular operating microscope for intra-operative visualization. Growing experience with posterior fossa endoscopy, however, has suggested that endoscopes may provide more comprehensive anatomical views of cerebellopontine angle. This report describes the case of a patient suffering from glossopharyngeal neuralgia who underwent fully endoscopic vascular decompression of the glossopharyngeal nerve. During this procedure the endoscope was used to survey the posterior fossa, guide the placement of insulating sponges, and conduct a final assessment of the intervention. We found the endoscope ideally suited to the constricted operating space of the posterior fossa, allowing for accurate localization and careful separation of the pathological vascular conflict with minimal brain retraction and no damage to surrounding structures. The versatility of endoscopy allows for superior visual appreciation of neurovascular conflicts in the posterior fossa. To date, endoscopy has primarily been used to supplement microscopy in cranial nerve decompression surgery. This report demonstrates how the endoscope can be used as the sole imaging modality in glossopharyngeal nerve decompression, with excellent results.
authors.affiliation: Division of Skull Base Surgery, Cedars-Sinai Medical Center, 8635 West Third Street, Los Angeles, CA 90048, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Jarrahy
authors.forename: Sung Tae
authors.initials: ST
authors.lastname: Cha
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Eby
authors.forename: George
authors.initials: G
authors.lastname: Berci
authors.forename: Hrayr K
authors.initials: HK
authors.lastname: Shahinian
mesh_terms: D000328:Adult; D003388:Cranial Fossa, Posterior / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005930:Glossopharyngeal Nerve / Q000601:surgery*; D020435:Glossopharyngeal Nerve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D014711:Vertebral Artery / Q000601:surgery