title: Microvascular decompression for neurovascular conflicts in the cerebello-pontine angle: which role for endoscopy?
abstract: BACKGROUND
  Microvascular decompression (MVD) is the surgical intervention designed to resolve neurovascular conflicts (NCs) in the cerebellopontine angle (CPA). Today, endoscopy is commonly used in many neurosurgical procedures. This study aims to retrospectively assess the usefulness of endoscopy during MVD, focusing on microscopic endoscopic-assisted (MEA) MVD.
  
  
  METHODS
  Between January 2010 and December 2012, 141 patients underwent MVD procedures: 119 (84.5 %) were affected by idiopathic trigeminal neuralgia (TN), 20 (14 %) by hemifacial spasm (HFS), 1 by glossopharyngeal neuralgia (GN) and 1 by TN and GN simultaneously; 128 (91 %) MVD were first time procedures, while 13 (9 %) were recurrences (10 TN, 3 HFS). Visualization techniques used were: pure microscopic in 89 (63 %) cases, fully endoscopic in 12 (8.5 %) and MEA in 40 (28.5 %). The MEA technique was used when the conflict was not clearly identified under microscopic view or it was not certainly resolved.
  
  
  RESULTS
  Overall, a NC was found in 130 (92 %) cases, while 11 patients had no intraoperative evidence of NC. Considering specifically the 40 MEA cases, 12 (8.5 % overall) conflicts not clearly visible with the microscope were revealed and solved, a complete conflict resolution was confirmed in 13 (9 % overall) cases, while an incomplete conflict resolution was shown in four cases (3 % overall).
  
  
  CONCLUSIONS
  Pure microscopic MVD remains the technique of choice. The endoscope is a useful adjunctive imaging tool in confirming NCs identified by the microscope, revealing conflicts missed by the microscopic survey alone and verifying adequate nerve decompression.
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milano, Italy. morganbroggi@hotmail.com
authors.forename: Morgan
authors.initials: M
authors.lastname: Broggi
authors.forename: Francesco
authors.initials: F
authors.lastname: Acerbi
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferroli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tringali
authors.forename: Marco
authors.initials: M
authors.lastname: Schiariti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Broggi
mesh_terms: D000368:Aged; D002530:Cerebellopontine Angle / Q000601:surgery; D004724:Endoscopy / Q000379:methods; D005260:Female; D020435:Glossopharyngeal Nerve Diseases / Q000601:surgery; D019569:Hemifacial Spasm / Q000601:surgery*; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D014277:Trigeminal Neuralgia / Q000601:surgery*