Endoscopic Microvascular Decompression for Primary Trigeminal Neuralgia: Surgical Experience and Early Outcomes

Objective This study aimed to investigate the clinical efficacy and early outcomes of endoscopic microvascular decompression (MVD) for primary trigeminal neuralgia (TN) and provide clinical experience for the application of full endoscopic techniques in MVD surgery. Methods Clinical data of 63 patients who underwent endoscopic MVD surgery at our institution between January 2020 and January 2023 were collected. The study analyzed the severity of facial pain using the Barrow Neurological Institute (BNI) Pain Intensity Score and evaluated the clinical outcomes and application of endoscopic MVD. Results Postoperatively, 59 patients (93.7%) achieved complete pain relief with a BNI score of I. Four patients (6.3%) had residual pain, managed effectively with medication (BNI score III). Recurrence was observed in 3 patients (4.8%) during the 12–36 months follow-up, with 2 patients (3.2%) scoring II and 1 patient (1.2%) scoring III on the BNI scale. Postoperative complications occurred in 6 patients (9.5%), including 3 cases of aseptic meningitis (4.8%), 2 cases of low-pressure syndrome (3.2%), and 1 case of hearing loss (1.6%). There were no fatalities, strokes, hearing impairments, facial paralysis, or other complications. Conclusion Endoscopic microvascular decompression for primary trigeminal neuralgia is safe and feasible. The wide-angle and multi-angle views and close observation are technical features and advantages of endoscopic surgery. The identification and confirmation of neurovascular compression are key to surgical success, but the lack of stereopsis and blind spots behind the scope need to be addressed and overcome.