title: Fully endoscopic microvascular decompression for trigeminal neuralgia: technique review and early outcomes.
abstract: OBJECTIVE
  Fully endoscopicmicrovascular decompression (E-MVD) of the trigeminal nerve was initially described more than 1 decade ago, but has not yet gained wide acceptance. The authors present the experience of their first 47 consecutive E-MVDs for trigeminal neuralgia (TN).
  
  
  METHODS
  All surgeries were performed by a single surgeon (J.Y.K.L.) at the Pennsylvania Hospital at the University of Pennsylvania. Patients prospectively completed pain scales before and after surgery by using the Brief Pain Inventory-Facial outcomes tool. All patients were called on the telephone, and the same outcome tool was administered without reference to their preoperative pain status.
  
  
  RESULTS
  Forty-seven patients (17 men) were identified and enrolled. Forty (85%) had Burchiel Type 1 TN. Vascular compression was observed at surgery in 42 patients (89%). No surgery was aborted or converted to microscope. One patient suffered permanent hearing loss, for a permanent neurological morbidity rate of 2%. Overall improvement in pain outcomes was excellent, with a median maximum pain intensity preoperatively of 10 and postoperatively of 0 (p< 0.0001). The mean interference with global function scores were 6.2 preoperatively and reduced to 1.0 at last follow-up (p < 0.0001). The mean interference with facial function was 7.3 preoperatively and reduced to 1.2 at last follow-up (p < 0.0001). The mean follow-up period after surgery was 15 ± 8 months.
  
  
  CONCLUSIONS
  In experienced hands, E-MVD offers superb visualization and illumination and is both safe and effective, at least in the short term. Further longer-term study is needed to compare E-MVD to traditional microscopic MVD.
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Leif-Erik
authors.initials: LE
authors.lastname: Bohman
authors.forename: John
authors.initials: J
authors.lastname: Pierce
authors.forename: James H
authors.initials: JH
authors.lastname: Stephen
authors.forename: Sukhmeet
authors.initials: S
authors.lastname: Sandhu
authors.forename: John Y K
authors.initials: JY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D056424:Decompressive Craniectomy; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D061145:Microvascular Decompression Surgery / Q000379:methods*; D008875:Middle Aged; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000601:surgery*
keywords: AICA = anterior inferior cerebellar artery; BPI = Brief Pain Inventory; CPA = cerebellopontine angle; E-MVD = fully endoscopicmicrovascular decompression; SCA = superior cerebellar artery; TN = trigeminal neuralgia; endoscope; microvascular decompression; minimally invasive surgery; trigeminal neuralgia