Endoscopic-Assisted Microvascular Decompression

Endoscopic-Assisted Microvascular Decompression

M. Yashar S. Kalani (Barrow Neurological Institute, USA), Michael R. Levitt (Barrow Neurological Institute, USA), Celene B. Mulholland (Barrow Neurological Institute, USA), Charles Teo (Prince of Wales Private Hospital, Australia) and Peter Nakaji (Barrow Neurological Institute, USA)
Copyright: © 2018 |Pages: 16
DOI: 10.4018/978-1-5225-5349-6.ch007

Abstract

Diseases of ephaptic transmission are commonly caused by vascular compression of cranial nerves. The advent of microvascular decompression has allowed for surgical intervention for this patient population. This chapter highlights the technique of endoscopic-assisted microvascular decompression for trigeminal neuralgia and hemifacial spasm. Endoscopy and keyhole techniques have resulted in a minimally invasive and effective treatment of symptoms for patients with neuralgia.
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Diagnostic Evaluation

Vascular compression syndromes are best diagnosed by careful history-taking and physical examination. High-resolution magnetic resonance imaging (MRI) with thin-slice T2-weighted sequences (Figure 1A-C), fast imaging employing steady-state acquisition (FIESTA), or constructive interference in steady-state (CISS) techniques may assist in the diagnosis by visualizing vascular compression in the cerebellopontine angle (CPA), but should only be used as an adjunct to clinical suspicion and to rule out uncommon etiologies such as tumors, multiple sclerosis, and arteriovenous malformations.

Figure 1.

(A) Axial T2-weighted fast imaging employing steady-state acquisition (FIESTA) magnetic resonance imaging (MRI) demonstrating a vascular loop of the right superior cerebellar artery compressing the right trigeminal nerve. (B) Axial T1- and (C) T2-weighted MRI demonstrating a vascular loop of the vertebral artery compressing the left facial nerve in a case of hemifacial spasm.

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