Pure Endoscopic Microvascular Decompression Using the Transposition Technique for Trigeminal Neuralgia and Hemifacial Spasm

Background: Successful microvascular decompression (MVD) in the treatment of trigeminal neuralgia (TN) and hemifacial spasm (HFS) involves two essential elements: precise identification of neurovascular conflicts and appropriate decompression. The transposition technique is an ideal decompression method in terms of long-term outcomes. Here, we describe purely endoscopic MVD with transposition for TN and HFS with minimal invasiveness. Material and Methods: We performed fully endoscopic MVD in 195 cases from January 2021 to December 2022, using 4-mm, 0- and 30-degree endoscopes, a pneumatic holding system, and single-shaft instruments. Results: The endoscope was introduced via a retrosigmoid keyhole. Neurovascular conflicts and perforators from the offending artery were clearly visualized by the endoscope. Transposition of the offending artery was safely performed with preservation of the perforators. Conclusion: Endoscopic MVD using a transposition technique is feasible, offering excellent surgical outcomes with minimal invasiveness.