Fully endoscopic microvascular decompression for trigeminal neuralgia: A retrospective study

Microvascular decompression (MVD) is the gold standard for treating drug-resistant classic trigeminal neuralgia (dcTN), with endoscopy enhancing surgical precision through improved visualization. This study evaluates the efficacy of fully endoscopic MVD for dcTN and presents our early experience. This retrospective study included patients with dcTN who underwent fully endoscopic MVD in the Department of Neurosurgery, the First Affiliated Hospital, Zhejiang University School of Medicine from November 2020 to February 2023. We recorded basic patient clinical information, clinical outcomes, offending vessels, complications, and recurrences, and assessed outcomes via the Barrow Neurological Institute (BNI) pain intensity score and the numeric rating scale (NRS) score. All 42 patients had dcTN with preoperative BNI scores of V and NRS scores of 8–10. Endoscopic visualization enabled the precise identification of neurovascular conflicts, including small and deeply located vessels. Immediately after surgery, 90.5% of patients achieved complete pain relief (BNI score of I, NRS score of 0). At the final follow-up, 85.7% of patients had complete pain relief. All patients’ pain was significantly relieved at immediate after surgery (0 vs. 9, p < 0.001) and at the final follow-up (0 vs. 9, p < 0.001), with lower NRS scores. Complications, including vertigo, headache, and transient facial numbness, occurred in 14.4% of patients and were manageable. Fully endoscopic MVD is a safe and effective treatment for dcTN.