Endoscopic inferior cerebellar artery in 96 patients. The

Endoscopic decompression
was performed in 230 patients. One patient also had an additional hemifacial
spasm. Age group ranged from 31 to 76 years (average 58 years). There were 124
female patients. All patients had unilateral pain distribution. It was more
common (n=132) on the right side. Maxillary, mandibular, ophthalmic and both
maxillary and mandibular division were involved in 116, 93, 1 and 20 patients
respectively. Offending vessels were found in 223 patients, while 7 had no
vessel or any other detectable lesion. These 7 patients underwent partial root
sectioning. Superior cerebellar artery as a vascular
conflict was seen in 174 patients. Offending vessel was an anterior inferior
cerebellar artery in 96 patients. The tortuous basilar artery was observed in
one patient. Small veins were found in 2 patients as a possible cause of
neuralgia. Total of 273 vessels were observed in 223 patients. Single and
double vessels conflict, as a possible cause of TN, was observed in 173 and 50
patients respectively. The compressing vessel was lying anterior to the nerve
in 39 patients (16.9%), which may have been missed by microscope. The arterial loop was found to be in contact with nerve root in 215
patients whereas grooving was observed in 35 patients. Twenty-one patients had
a displacement of the nerve due to arterial loop.


The hospital stay after surgery was from 2
to 12 days (average 2.6 days). Although bulky suprameatal tubercle was observed
in 6 patients, the full course of nerve from Meckel’s cave to pons could be
visualized very well without retraction of brain or nerve. There was no need
for any drilling of bone. Completeness of decompression could
be assessed in all patients with the help of an angled endoscope. The whole procedure was performed by endoscope without
the use of microscope except one patient for profuse bleeding. This also helped
in avoiding wastage of time in changing between microscope and endoscope. Duration
of operation was from 75 to180 minutes (average 105 minutes).

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Complete, satisfactory
and none pain relief was observed in 204 (88.7%), 11 (5.8%) and 15 (6.5%)
patients respective after surgery. Recurrence was observed in 25 patients
(10.9%) at an average follow up of 60 months. Only 5 patients out of 25 recurrences
opted for re-surgery using the endoscopic technique. There was a vascular loop,
adhesions leading to traction on the nerve, and granuloma in 2, 2, and 1
patient respectively as a possible cause of recurrence. All 5 recurrent
patients had complete pain relief after re-surgery. No additional difficulty
was encountered in re-surgery. There was no mortality in the present study. Temporary trigeminal dysthesias was observed in 9
patients (3.9%). Temporary vertigo, facial paresis, CSF leak, and decreased
hearing was observed in 8, 8, 7, 4 patients respectively. Permanent reduced
hearing continued in one patient out of those 4 patients. Intra-operative
bleeding due rupture of the petrous vein was seen in 2 patients. This bleeding
could be controlled by an endoscopic technique in one patient. The microscope
was needed for bleeding control in one patient.