Surgical Outcomes of Microvascular Decompression vs. Endoscope-Assisted Microvascular Decompression

Abstract

Objective:  To compare the surgical outcomes of conventional microvascular decompression (MVD) and endoscope-assisted microvascular decompression (EA-MVD) in patients with medically refractory primary trigeminal neuralgia (TN), and to evaluate the additional intraoperative value of endoscopic visualization.

Materials & Methods:  This retrospective, single-center study involved 35 patients with primary TN who received MVD from July 2024 to December 2025. Twenty patients were treated with conventional MVD, and 15 with EA-MVD. Postoperative pain relief (Barrow Neurological Institute pain intensity score), recurrence, intraoperative findings, operative time, and postoperative complications were the outcomes.

Results:  At discharge, overall satisfactory pain relief (BNI I–II) was obtained in 94.3% of patients, and at final follow-up, in 82.9% of patients. There were no significant differences between the two groups for pain relief, recurrence, or complications (p>0.05). Previously unrecognized neurovascular conflicts (33.3%) and incompletion of decompression (20.0%) were identified on EA-MVD and led to further decompression. While the operative time was slightly longer in the EA-MVD group (112.6 minutes vs. 95.4 minutes, p = 0.02), there were no significant differences in complication rates.

Conclusion:  EA-MVD provides clinical outcomes comparable to those of conventional MVD while improving intraoperative visualization and identification of occult neurovascular conflicts without increasing complications.