ỨNG DỤNG PHẪU THUẬT NỘI SOI GIẢI ÉP XUNG ĐỘT MẠCH MÁU THẦN KINH TRONG ĐIỀU TRỊ ĐAU DÂY V

Abstract

Introduction: Microvascular decompression (MVD) of the trigeminal nerve is the gold standard surgical treatment for medically refractory classical trigeminal neuralgia.  Sometime MVD surgery fail due to incomplete decompression of the responsible vessel cause a poor visual field. Endoscopy in decompression of neurovascular conflicts is a new direction, which has been applied in some countries with high success rates and overcomes the disadvantages of MVD. Endoscopy has significantly advanced surgery and provides enhanced visualization of the cerebellopontine angle and its critical neurovascular structures. However, in Vietnam, endoscopic surgery to decompress neurovascular conflicts has not been widely studied and applied. We evaluate the outcomes of treatment of fully endoscopic microvascular decompression for trigeminal neuralgia. Patients & Methods: A retrospective study in a single institution of 20 patients with TN who received EVD between August 2024 and May 2025. All patients were diagnosed trigerminal neuralgia based on clinical, MRI, failed drug medical treatment or drug-intolerant allergy, or recurrent V nerve pain. Indications for surgery are the same as microsurgery to relieve neurovascular conflicts. All patient underwent EVD via the suboccipital retrosigmoid approach with out microscopy at any stage. Evaluate results based on surgery time, difficulties and advantages during surgery, intraoperative lighting, exploration of nerve V in the cerebellopontine angle from the brainstem until CN V enters the temporal fossa, and identify CN V, causing vessels, degree of compression, ability to release conflict. All operations were performed by the surgeons of  Center for Neurosurgery - Viet Duc Friendship Hospital. Follow-up was conducted by outpatient and telephone interviews. The degree of facial pain was graded using the Barrow Neurological Institute (BNI) pain intensity score; a BNI of 1 was considered as the best result while a BNI of 2 or 3 was considered as a satisfactory result. Results: All 20 patients with severe preoperative pain (BNI of 5) achieved immediate relief or complete control of pain after surgery (BNI of 1 to 2). Vascular conflicts were observed during surgery in all of the patients. None of the patients experienced hearing loss, facial paralysis, intracranial infection, cerebrospinal fluid leakage, cerebral hemorrhage, or death, following the operation. Conclusion: EVD can provide a clear surgical field of view and reduce the risk of surgical injury. Our findings indicate that EVD is a safe and effective surgical method for the treatment of TN.