Hybrid Microvascular Decompression For Cranial Neurovascular Compression Syndromes: A Retrospective Case Series and Surgical Nuances.

Abstract

Microvascular decompression (MVD) remains the gold standard for the treatment of neurovascular compression syndromes (NVCS). Adjunctive visualization tools have been introduced to improve visualization beyond the direct microscopic line-of-sight. This study evaluated the technical feasibility, safety, and short- to mid-term clinical outcomes of QEVO®-assisted microscopic MVD. This retrospective series included 43 patients who underwent QEVO®-assisted MVD for trigeminal neuralgia (TN, 31), hemifacial spasm (HFS, 11), and cochleo-vestibular nerve compression syndrome (1) between January 2021 and September 2024 at ASST Cremona (Italy). The study was designed as a descriptive case series without a control group. A "microscopically hidden" NVC was defined when was not identified during standard microscopic inspection, became apparent following QEVO® inspection, and prompted additional microscopic arachnoid dissection and/or vessel mobilization. No QEVO®-related adverse events occurred during surgery. QEVO® facilitated the identification of "hidden" NVCs in four patients (13%) with TN and one (9%) with HFS. All "hidden" NVCs in TN exhibited a "mixed" compression pattern on the anterior aspect of the trigeminal root entry zone (REZ). The "hidden" NVC identified in HFS consisted of a "tandem" compression pattern at the facial REZ. At the last follow-up, 84% of patients with TN achieved a Barrow Neurological Institute pain score grade I or II, while all patients with HFS reached complete symptom resolution. QEVO® proved to be a feasible adjunctive visualization tool that can be integrated into the standard microscopic workflow, facilitating the identification of additional neurovascular relationships particularly in patients with complex NVC patterns.