Microscope may fail to detect culprit vessel at the root entry zone or distally especially when suprameatal tubercle is prominent and when compressing vessel is lying anteriorly to trigeminal nerve without using significant brain retraction. Endoscopic techniques allow better visualization of nerve and vascular conflict.Material and Methods:
A retrospective study of 178 patients of endoscopic vascular decompression without use of microscope was done. The follow-up period ranged from 12 to 108 months (average 58 months).Results:
Age ranged from 32 to 75 years. Neuralgia was in maxillary, mandibular and both (maxillary and mandibular) divisions in 89, 72 and 16 patients respectively. Duration of operation and hospital stay ranged from 85 -160 minutes and 2 to 10 days (average 2.7 days) respectively. Offending vessels could be identified in 174 patients. Superior cerebellar artery, anterior inferior cerebellar artery, single vessel, double vessels conflicts and vessel anterior to nerve were seen in 136, 76, 133, 41 and 31 patients respectively. The pain was relieved in 167 patients (93.8 %). Temporary complications included trigeminal dysesthesias (3.9%), cerebrospinal fluid leak (2.8%), facial paresis (3.9%), decreased hearing (1.7%) and vertigo (3.3%) patients. Permanent hearing loss, recurrence of pain and re-surgery was observed in 1, 7 and 3 patients respectively.Conclusion:
Endoscopic vascular decompression is safe, effective technique for vascular decompression with advantages of better visualization of entire course of nerve and vascular conflict without brain retraction. It also helps in better detection of completeness of surgery.