Microvascular decompression using a fully transcranial neuroendoscopic approach

Fully endoscopic microvascular decompression for hemifacial spasm: a clinical study and analysis

Fully endoscopic microvascular decompression (MVD) of the facial nerve is the main surgical treatment for hemifacial spasm. However, the technique presents distinct surgical challenges. We retrospectively analyzed prior cases to consolidate surgical insights and assess clinical outcomes. Clinical data from 16 patients with facial nerve spasms treated at the Department of Neurosurgery in the First Affiliated Hospital of Bengbu Medical College, between August 2020 and July 2023, were retrospectively examined. Preoperatively, all patients underwent magnetic resonance angiography to detect any offending blood vessels; ascertain the relationship between offending vessels, facial nerves, and the brainstem; and detect any cerebellopontine angle lesions. Surgery involved endoscopic MVD of the facial nerve using a mini Sigmoid sinus posterior approach. Various operative nuances were summarized and analyzed, and clinical efficacy, including postoperative complications and the extent of relief from facial paralysis, was evaluated. Fully endoscopic MVD was completed in all patients, with the offending vessels identified and adequately padded during surgery. The offending vessels were anterior inferior cerebellar artery in 12 cases (75%), vertebral artery in 3 cases (18.75%), and posterior inferior cerebellar artery in 1 case (6.25%). Intraoperative electrophysiological monitoring revealed that the lateral spread response of the facial nerve vanished in 15 cases and remained unchanged in 1 case. Postoperative facial spasms were promptly alleviated in 15 cases (93.75%) and delayed in 1 case (6.25%). Two cases of postoperative complications were recorded-one intracranial infection and one case of tinnitus-both were resolved or mitigated with treatment. All patients were subject to follow-up, with no instances of recurrence or mortality. Fully endoscopic MVD of the facial nerve is safe and effective. Proficiency in endoscopy and surgical skills are vital for performing this procedure.

Treatment of brainstem and fourth ventricle lesions by the full neuroendoscopic telovelar approach

OBJECTIVE

To explore the surgical techniques, advantages, and disadvantages of neuroendoscopic telovelar approach in the treatment of brainstem and fourth ventricle lesions.

METHODS

The clinical data of 5 patients treated by neuroendoscopic telovelar approach from March 2020 to March 2022 were analyzed retrospectively.

RESULTS

Among the 5 patients, there were 3 cavernous hemangiomas in pontine arm and 2 tumors in brainstem and fourth ventricle. All patients could successfully complete the operation, and 4 patients recovered well, other 1 patient discharged automatically for serious complications of other systems after the operation.

CONCLUSION

The telovelar approach has gained popularity as a safe and effective strategy for lesions in fourth ventricular and brainstem. However, without removing the posterior arch of the atlas, it is difficult to enter the upper part of the fourth ventricle under a microscope. Transcranial neuroendoscopy can effectively compensate for the shortcomings of microscopy, whether used as an auxiliary measure for microsurgery or alone with proficient endoscopic techniques, it will provide greater application in minimally invasive surgery for fourth ventricle and brainstem lesions. By utilizing the excellent degree of freedom of transcranial neuroendoscopy, there is no need to open the posterior arch of the atlas, making the surgery more minimally invasive. However, the sample size of this study is small, and it was completed under the very mature neuroendoscopic technology of our team. Its general safety and practicality still require extensive clinical research validation.

Clinical application of 3D-Slicer + 3D printing guide combined with transcranial neuroendoscopic in minimally invasive neurosurgery

To explore the clinical advantages of 3D-Slicer + 3D printing guide combined with transcranial neuroendoscopic in minimally invasive neurosurgery. By collecting the datum of patients who underwent craniotomy under 3D-Slicer + 3D printing guide plate positioning combined with transcranial neuroendoscopic in our hospital from October 2021 to February 2022, this paper introduces the accurate planning and positioning lesions of patients before operation and the minimally invasive operation of intraoperative neuroendoscopic and analyses clinical data such as lesion size and surgical bone window size. We collected the case datum of 16 patients who underwent craniocerebral surgery with 3D-Slicer + 3D printing guide combined with transcranial neuroendoscopic, including 5 males and 11 females, aged 46-76 years, including 6 brain tumors (3 meningiomas, 1 glioblastoma, 2 lung cancer brain metastases), 2 cavernous hemangioma, 7 hydrocephalus and 1 chronic subdural hematoma. The lesions of the 16 patients were located accurately before operation and the target areas were reached quickly during operation. Postoperative imaging datum confirmed that the lesions was removed fully, and the ventricular end of shunt tube was in good position. The technology of 3D-Slicer + 3D printing guide plate combined with transcranial neuroendoscopic is not difficult, which has many advantages such as inexpensive equipment, simple operation, easy learning, accurate positioning, and minimally invasive surgery. It is considered to be a practical technology that is feasible, reliable, convenient for diagnosis, preoperative planning and minimally invasive surgery. It is suitable for promotion in neurosurgery and other surgical departments of all medical institutions.