Endoscope-Assisted Microvascular Decompression for Hemifacial Spasm: A Consecutive Series Using a Hybrid Visualization Strategy.

Abstract

Microvascular decompression (MVD) is the most effective treatment for hemifacial spasm (HFS). However, microscopic visualization alone may insufficient for assessing the neurovascular relationship, and the optimal role of endoscopy remains unsettled. The purpose of this study was to evaluate the feasibility, safety, and outcomes of endoscope-assisted MVD (EA-MVD) for HFS. A retrospective review was performed of 200 consecutive patients who underwent EA-MVD between January 2019 and June 2021. The endoscope was used to inspect the neurovascular relationship before and after microscopic decompression. Clinical outcomes, intraoperative neurophysiological monitoring findings, and complications were analyzed. The median follow-up duration was 20 months. Complete resolution of HFS was achieved in 184 patients (92%), including 166 early responders (83%) and 18 delayed responders (9%). Abnormal muscle response disappeared intraoperatively in 176 of 191 patients (92%). Facial palsy occurred in 23 patients (12%), with permanent facial weakness in 4 patients (2%). Hearing loss occurred in 6 patients (3%), including permanent deafness in 2 patients (1%). No complications were directly attributable to endoscope use. Endoscope-assisted MVD is a safe and effective hybrid surgical technique that offers a reproducible adjunctive workflow without evident endoscope-related morbidity in this series.