微血管减压术治疗老年三叉神经痛的有效性和安全性分析

目的探讨微血管减压术治疗老年三叉神经痛的有效性和安全性。方法共286例原发性三叉神经痛患者[≥70岁50例(老龄组),70岁236例(低龄组)]均采用患侧枕下经乙状窦后入路行微血管减压术,记录术后并发症,包括术侧面部麻木感、术侧听力下降、脑脊液漏、手术切口愈合欠佳、颅内感染、脑积水;采用Barrow神经病学研究所(BNI)三叉神经痛分级评价疼痛缓解;记录随访期间复发率。结果 286例患者中36例(12.59%)出现术后并发症,低龄组29例(12.29%),老龄组7例(14%),组间差异无统计学意义(χ~2=0.110,P=0.740),为术侧面部轻度麻木感18例(6.29%)、术侧听力下降13例(4.55%)、脑脊液漏1例(0.35%)、手术切口愈合欠佳1例(0.35%)、颅内感染2例(0.70%)和脑积水1例(0.35%)。随访29.43个月,随访的216例低龄组患者中170例(78.70%)疼痛完全缓解(BNI分级Ⅰ级),10例(4.63%)疼痛部分缓解(BNI分级Ⅱ~Ⅲ级),14例(6.48%)疼痛无缓解(BNI分级Ⅳ~Ⅴ级),22例(10.19%)复发;随访的44例老龄组患者中35例(79.55%)疼痛完全缓解(BNI分级Ⅰ级),2例(4.55%)疼痛部分缓解(BNI分级Ⅱ~Ⅲ级),1例(2.27%)疼痛无缓解(BNI分级Ⅳ~Ⅴ级),6例(13.64%)复发,组间预后差异无统计学意义(χ~2=1.530,P=0.675)。Kaplan-Meier曲线显示,随着随访时间的延长,两组患者术后疼痛完全缓解率均逐渐下降。结论单纯微血管减压术治疗老年三叉神经痛安全、有效,未出现死亡或神经功能障碍等严重并发症。     

椎-基底动脉压迫性三叉神经痛微血管减压手术策略及分析

目的探讨微血管减压术治疗锥-基底动脉压迫性三叉神经痛病人的手术策略。方法回顾性分析14例锥-基底动脉压迫性三叉神经痛病人的临床资料,采用微血管减压术。椎动脉直接压迫9例,基底动脉直接压迫5例;同时伴其他小血管压迫,包括小脑上动脉8例、小脑前下动脉3例和静脉3例。压迫点位于三叉神经脑池段9例,位于入髓区(root entry zone,REZ)5例。结果术后症状即刻完全缓解11例,明显缓解3例。随访3~32个月,仅1例病人术后出现面部麻木,其他未见复发和严重并发症。结论遵循恰当的手术策略,微血管减压术是治疗椎-基底动脉压迫所致三叉神经痛最有效的手段之一。     

微血管减压术合并梳理术治疗复发三叉神经痛

目的探讨微血管减压术合并梳理术治疗复发三叉神经痛的疗效,分析复发原因。方法自2010年6月至2014年12月13例微血管减压术(microvascular decompression,MVD)术后复发患者行MVD术合并梳理术(internal neurolysis,IN)。对其临床资料、影像资料、手术资料回顾性分析。结果三叉神经MVD术后复发原因主要为血管压迫和蛛网膜粘连,其次为Teflon肉芽肿。随访期结束时,疼痛强度分级(the Barrow neurological institute pain intensity scale,BNI)为BNI I级9例,BNI II级2例,BNI III级1例,BNI IV级1例。术后细菌性脑膜炎1例,头皮延迟愈合1例和面部麻木13例。结论三叉神经MVD术后复发原因主要为血管压迫和蛛网膜粘连,其次为Teflon肉芽肿。对于复发三叉神经痛患者来说,MVD术合并梳理术是可行的治疗选择。     

悬吊法在椎-基底动脉型三叉神经痛显微血管减压术中的应用

目的探讨椎-基底动脉悬吊法在显微血管减压术治疗三叉神经痛中的应用。方法回顾性分析30例因椎-基底动脉压迫致三叉神经痛病人的临床资料,在显微血管减压术中应用椎-基底动脉悬吊法。结果术后总有效率100%,治愈率93%(28/30),平均随访20个月,无复发病例。术后并发症包括:面部麻木2例,听力下降1例,在随访期间均痊愈;无菌性脑膜炎2例,出院前治愈。结论在治疗三叉神经痛的手术中应用椎-基底动脉悬吊法可提高治愈率,减少并发症,降低复发率。     

椎基底动脉延长扩张致三叉神经痛的临床分析(附4例报告并文献复习)

目的探讨椎基底动脉延长扩张致三叉神经痛的临床特点及诊治方法。方法回顾性分析4例患者的临床症状、影像学表现、治疗方法及随访情况,并检索相关文献,进行总结分析。结果 4例男性患者,临床表现为三叉神经痛,出现症状的时间为7个月-3年,经MRI和CTA证实由椎基底动脉延长扩张压迫三叉神经所致,其中2例接受部分感觉根切断术,1例接受显微血管减压术,1例仅接受药物治疗。所有患者治疗后症状都明显改善,手术患者术后面部疼痛完全消失,但部分感觉根切断术的患者术后遗留面部轻微麻木后遗症。结论椎基底动脉延长扩张症致三叉神经痛临床较少见,根据患者个体差异,可采取药物治疗、部分感觉根切断术、显微血管减压术等不同治疗方案,显微血管减压术是一种较为理想的手术方式。     

显微血管减压术治疗三叉神经痛和面肌痉挛的技术差别(附37例报告)

目的为了提高手术安全性和疗效,减少术后并发症,探讨显微血管减压术治疗三叉神经痛和面肌痉挛的方法和技术细节差别。方法回顾性分析37例显微血管减压术手术患者,其中三叉神经痛15例,面肌痉挛22例,分析术中体位,切口,骨窗,责任血管压迫等细节,观察二者术后疗效。结果三叉神经痛患者术后疼痛立即完全缓解14例,1例延迟缓解。所有面肌痉挛患者痉挛症状术后即刻消失,无严重并发症。随访半年~2年,1例三叉神经痛患者复发,所有面肌痉挛患者未见复发。结论显微血管减压术是治疗三叉神经痛和面肌痉挛的有效治疗方法,但在术中体位、切口、骨窗、责任血管压迫等具体操作细节方面有细微差别,了解这些差别有助于增加手术安全性,取得更好的疗效。     

原发性三叉神经痛显微血管减压术中岩上静脉的处理策略

目的探讨原发性三叉神经痛显微血管减压(MVD)术中岩上静脉与三叉神经的位置关系及其相应的处理策略。方法回顾性分析2022年10月至2023年3月中日友好医院神经外科同一术者主刀治疗的69例原发性三叉神经痛患者的临床资料。将岩上静脉与三叉神经的相对位置关系分为3型:Ⅰ型为交叉型, Ⅱ型为伴随型, Ⅲ型为平行型。对于Ⅰ型患者, 充分解剖分离岩上静脉与三叉神经和(或)小脑幕之间的蛛网膜, 通过此空间进行第一间隙责任血管的减压;对于Ⅱ型患者, 需尽可能地将岩上静脉与三叉神经及其神经根进/出脑干区的蛛网膜分离, 并置入垫棉隔离;对于Ⅲ型患者, 以吸引器将岩上静脉轻轻推开, 完整显露第一间隙进行减压。以巴罗神经学研究所(BNI)疼痛分级评估手术疗效。出院后采用门诊和电话的方式随访患者的BNI疼痛分级。结果 69例患者中, 岩上静脉与三叉神经的位置关系为Ⅰ型者占比为52.2%(36例), Ⅱ型占比为30.4%(21例), Ⅲ型占比为17.4%(12例);MVD术中均完整保留岩上静脉。术后7 d内, 患者BNI疼痛分级Ⅰ级68例, Ⅱ级1例。术后无一例发生听力障碍、静脉回流障碍等并发症。69例患者的随...     

单纯微血管减压术治疗三叉神经痛的有效性和安全性分析

目的探讨微血管减压术治疗原发性三叉神经痛的有效性和安全性,并筛查其复发相关危险因素。方法共286例单纯行微血管减压术的原发性三叉神经痛患者,分别于术前、术后和随访期间采用Barrow神经病学研究所(BNI)三叉神经痛分级评价疼痛缓解;记录术后并发症,包括术侧面部麻木感、术侧听力下降、脑脊液漏、手术切口愈合欠佳、颅内感染、脑积水;记录随访期间复发情况。单因素和多因素前进法Logistic回归分析筛查三叉神经痛复发相关危险因素。结果 286例患者中术后18例(6.29%)出现术侧面部轻度麻木感,13例(4.55%)术侧听力下降,1例(0.35%)脑脊液漏,1例(0.35%)手术切口愈合欠佳,2例(0.70%)颅内感染,1例(0.35%)脑积水。随访期间26例(9.09%)失访,13例(4.55%)术后疼痛无缓解,13例(4.55%)术后疼痛部分缓解,234例(81.82%)术后疼痛完全缓解。234例术后疼痛完全缓解患者平均随访31.29个月,1例(0.35%)死于心脏病,28例(9.79%)复发。Kaplan-Meier曲线显示,术后疼痛完全缓解率随着随访时间的延长而逐渐下降,其中术后1年复发率5.4%、术后3年15.2%、术后5年21.2%。单因素和多因素前进法Logistic回归分析显示,术前BNI分级Ⅴ级是三叉神经痛复发的独立危险因素(OR=2.385,95%CI:1.063～5.353;P=0.035)。结论微血管减压术治疗三叉神经痛安全、有效,无死亡或神经功能障碍等严重并发症。     

显微血管减压治疗三叉神经痛和面肌痉挛的近期疗效观察

经后颅窝入路对7例三叉神经痛、5例面肌痉挛行显微血管减压手术治疗。7例三叉神经痛患者中有6例发现三叉神经根为动脉压迫,1例为静脉压迫。7例病人于血管减压后疼痛完全消失,且无任何神经缺陷遗留。5例面肌痉挛患者中4例面神经根有动脉压迫。血管减压后症状都获得明显缓解,1例在面神经根部未发现血管压迫,此例术后疗效不佳。微血管对神经根的压迫是三叉神经痛和面肌痉挛的一种重要病因。显微血管减压治疗这两种疾病的近期疗效甚佳,远期疗效尚待进一步观察。     

微血管减压术治疗原发性三叉神经痛

目的提出微血管减压术是治疗原发性三叉神经痛的最佳手术方式。方法报告了12例原发性三叉神经痛患者行微血管减压术,其中11例发现三叉神经入脑干区动脉压迫神经根,将压迫血管与神经根分离,在其间植入纤维蛋白海绵或聚四氟乙烯片维持分离状态,术后除1例疼痛减轻外,其余疼痛完全缓解,另1例术中未发现责任血管,但在神经根远侧段发现有粘连,将粘连松解,使神经根游离。结果所有患者术后疼痛减轻或缓解,所有病例无并发症。结论微血管减压术治疗原发性三叉神经痛是去除病因的手术方式,对已行微血管减压术后复发的患者再次行微血管减压术亦可获得满意疗效,作者还认为,神经内镜辅助微血管减压术顺应了当今微侵袭外科的趋势,将有望被更多地用来治疗原发性三叉神经痛。     

不同分支三叉神经痛患者显微血管减压术后的疗效分析(附200例报告)

目的观察不同分支三叉神经痛(TN)患者显微血管减压术(MVD)后的疗效,分析影响预后的相关因素。方法回顾性分析2017年1月至2018年9月中南大学湘雅医院神经外科行MVD的TN患者的临床资料,共200例。其中疼痛累及范围位于三叉神经第1支(V1)分布区者7例,第2支(V2)分布区者23例,第3支(V3)分布区者27例,V1~V2分布区者29例,V2~V3分布区者64例,V1~V3分布区者50例。术后1个月、3个月、1年采用巴罗神经学研究所(BNI)疼痛强度评分标准评估疼痛缓解情况。分析影响疼痛缓解率的相关影响因素。结果200例患者中,术后1个月、3个月、1年的疼痛缓解率分别为91.5%(183例)、83.0%(166例)及67.0%(134例);其中166例累及分支包含V2支组的上述3个时间点的疼痛缓解率分别为89.8%(149例)、81.3%(135例)及64.5%(107例),34例累及分支未包含V2支组的疼痛缓解率分别为100.0%(34例)、91.2%(31例)、79.4%(27例)。两组比较,术后1年的疼痛缓解率差异有统计学意义(P=0.012)。多因素logistic回归分析结果显示,累及分支包含V2支是TN患者MVD后疼痛缓解的独立危险因素(OR=0.688,95%CI:0.474~0.996,P=0.048)。结论累及分支包含V2支的TN患者,MVD后疼痛缓解率相对低于未累及者。     

伽玛刀放射外科治疗药物难治性三叉神经痛的长期疗效及其影响因素分析

目的探讨伽玛刀放射外科(GKRS)治疗药物难治性三叉神经痛(TN)患者的长期疗效及其相关影响因素。方法回顾性分析2009年1月至2019年9月内蒙古医科大学附属医院头部伽玛刀治疗中心采用GKRS治疗的293例药物难治性TN患者的临床资料。治疗后对所有患者进行临床随访,随访内容包括判断患者的疼痛缓解程度、并发症发生及复发情况。疼痛缓解程度依据巴罗神经学研究所(BNI)疼痛强度量表评级,其中Ⅰ~Ⅲb级为疼痛缓解有效,Ⅳ、Ⅴ级为疼痛缓解无效。采用单因素和多因素logistic回归分析法判断影响患者治疗后疼痛缓解和发生面部麻木的危险因素。结果293例患者的中位随访时间为64个月(6~132个月)。至末次随访,270例患者疼痛缓解有效,另23例无效;疼痛有效缓解率为92.2%(270/293)。293例患者中,术后存在面部麻木伴蚁走感80例(27.3%),单纯蚁走感26例(8.9%),眼角抽搐14例(4.8%),眼睛异物感、干涩等6例(2.0%),耳鸣3例(1.0%),味觉减退或丧失5例(1.7%),咀嚼功能障碍4例(1.4%)。随访期间,17例(5.8%)患者复发;复发的中位时间为24个月(14~81个月)。多因素logistic回归分析结果显示,存在既往治疗史是影响患者治疗后疼痛缓解的危险因素(OR=3.419,95%CI:1.264~9.248,P=0.015),与照射剂量<80 Gy比较,80 Gy的照射剂量对疼痛的缓解效果好(OR=0.252,95%CI:0.071~0.888,P=0.032);存在既往治疗史(OR=2.533,95%CI:1.194~5.373,P=0.015)和血管压迫神经(OR=5.865,95%CI:2.538~13.556,P<0.001)是影响患者治疗后出现面部麻木的危险因素。结论采用GKRS治疗药物难治性TN的疼痛缓解率较高,治疗后并发症以面部麻木最常见。存在既往治疗史的TN患者疼痛缓解较差,术后易出现面部麻木;照射剂量80 Gy的患者疼痛缓解较好;存在血管压迫神经的患者术后易出现面部麻木。     

原发性三叉神经痛微血管减压术后复发的影响因素分析

目的 探讨微血管减压术（MVD）治疗原发性三叉神经痛（PTN）的疗效及术后复发的影响因素。方法 回顾性分析2014年1月至2017年1月MVD治疗的164例PTN的临床资料。术后随访12~48个月， 中位随访时间31个月。采用巴罗神经学研究所（BNI）面部疼痛分级标准评估疗效。采用多因素Logistic回归分析检验术后复发的影响因素。结果 术后1周BNI分级Ⅰ~Ⅱ级139例（84.76%），Ⅲ级25例 （15.24%）；术后11例（6.70%）出现并发症。随访期间共复发31例，复发率为18.90%。多因素Logistic回归分析显示，病程≥5年、减压未充分、压迫有移位是影响PTN病人MVD后复发的独立危险因素 （P<0.05）。结论 MVD治疗PTN临床疗效确切，安全性较高；对于病程长、未充分减压的病人，应注意加强随访，防治复发。     

Valor predictivo de la resonancia magnética para la identificación de compresiones neurovasculares en la neuralgia del trigémino

IntroductionMicrovascular decompression (MVD) is accepted as the only aetiological surgical treatment for refractory classic trigeminal neuralgia (TN). There is therefore increasing interest in establishing the diagnostic and prognostic value of identifying neurovascular compressions (NVC) using preoperative high-resolution three-dimensional magnetic resonance (MRI) in patients with classic TN who are candidates for surgery.MethodsThis observational study includes a series of 74 consecutive patients with classic TN treated with MVD. All patients underwent a preoperative three-dimensional high-resolution MRI with DRIVE sequences to diagnose presence of NVC, as well as the degree, cause, and location of compressions. MRI results were analysed by doctors blinded to surgical findings and subsequently compared to those findings. After a minimum follow-up time of six months, we assessed the surgical outcome and graded it on the Barrow Neurological Institute pain intensity score (BNI score). The prognostic value of the preoperative MRI was estimated using binary logistic regression.ResultsPreoperative DRIVE MRI sequences showed a sensitivity of 95% and a specificity of 87%, with a 98% positive predictive value and a 70% negative predictive value. Moreover, Cohen's kappa (CK) indicated a good level of agreement between radiological and surgical findings regarding presence of NVC (CK 0.75), type of compression (CK 0.74) and the site of compression (CK 0.72), with only moderate agreement as to the degree of compression (CK 0.48).After a mean follow-up of 29 months (range 6-100 months), 81% of the patients reported pain control with or without medication (BNI score i-iiiI). Patients with an excellent surgical outcome, i.e. without pain and off medication (BNI score i), made up 66% of the total at the end of follow-up. Univariate analysis using binary logistic regression showed that a diagnosis of NVC on the preoperative MRI was a favorable prognostic factor that significantly increased the odds of obtaining an excellent outcome (OR 0.17, 95% CI 0.04-0.72; P=.02) or an acceptable outcome (OR 0.16, 95% CI 0.04-0.68; P=.01) after MVD.ConclusionsDRIVE MRI shows high sensitivity and specificity for diagnosing NVC in patients with refractory classic TN and who are candidates for MVD. The finding of NVC on preoperative MRI is a good prognostic factor for long-term pain relief with MVD.     

Microvascular decompression for recurrent trigeminal neuralgia

Recurrence of trigeminal neuralgia (TN) symptoms after microvascular decompression (MVD) is a challenge for neurosurgeons. This study evaluates the indication, efficacy and safety of re-do MVD. We retrospectively reviewed consecutive patients who underwent MVD for TN from January 2000 to June 2012. The parameters of study interest were pre-operative magnetic resonance tomographic angiography (MRTA) findings and operative findings. Pain outcome was scored using the Barrow Neurological Institute (BNI) grading scale. Twelve patients underwent re-do MVD following recurrence of pain. Vascular compression was detected on pre-operative MRTA images in eight patients, a small mass was found in two patients, and pre-operative imaging was negative in two patients. Of the eight patients with a positive finding of arterial conflict, a vascular loop was identified intra-operatively in five patients (62.5%); in two (25.0%) a small granuloma filled with Teflon fibers was found compressed the trigeminal nerve; and in one patient (12.5%) only dense arachnoid adhesions were found around the trigeminal nerve. For the two patients with mass compression on MRTA images, a granuloma was found during operation. Neurovascular compression was found in the two patients with negative preoperative MRTA images. Re-do MVD is a safe and effective treatment for recurrent TN when indicated by a prolonged pain-free period following the first surgery.     

枕下乙状窦后入路手术治疗三叉神经痛的术式选择

目的探讨枕下乙状窦入路手术治疗三叉神经痛术中手术方式的选择。方法对39例原发性三叉神经痛患者的临床资料进行回顾性分析。其中31例患者术中有明确的血管压迫,仅行微血管减压术(MVD)手术;6例患者血管压迫不明显,行MVD+三叉神经梳理术(TNC);3例患者行三叉神经感觉根部分离断术(PSR),1例患者行二次手术。对患者术后的疗效及并发症进行分析。结果 31例行MVD手术患者,术后疼痛立即完全缓解26例,延迟缓解2例,无效3例,总有效率90.6%。6例行MVD+TNC的患者和3例行PSR手术的患者术后疼痛均立即缓解。结论为提高手术治疗三叉神经痛的治愈率,应根据术中不同情况决定不同的手术方式。对于老年人及不能耐受第二次手术的患者,更应积极行PSR手术。     

Percutaneous balloon compression for persistent or recurrent trigeminal neuralgia after microvascular decompression: personal experience of 28 patients

The objective of this study is to investigate the long-term effects of percutaneous balloon compression (PBC) for treating persistent or recurrent trigeminal neuralgia (TN) after microvascular decompression (MVD). The clinical features, surgical findings, outcomes, and complications of 28 patients underwent PBC for TN in Nanjing Drum Tower Hospital between April 2011 and March 2015 were analyzed retrospectively. All the patients had received MVD before but they did not get cured or the symptom relapsed during follow-up. Twenty-six patients (92.9%) experienced immediate pain relief; one patient (3.6%) improved but still had occasional pain. The other one (3.6%) had no pain relief and repeat PBC was performed with complete resolution of the symptom. With a mean follow-up of 39.9 months, ranging from 24 to 65 months after surgery, 24 (85.7%) patients remained pain-free; three patients (11.1%) had a relapse. Surgical complications included facial numbness in 27 patients (96.4%), masseter muscle weakness in 10 patients (35.7%), and diplopia secondary to abducens nerve palsy in one patient (3.6%). None of the patients had serious surgical morbidities. PBC is a minimally invasive, safe, and effective treatment for trigeminal neuralgia, especially suitable for patients with persistent or recurrent TN after MVD.     

微血管减压术治疗面肌痉挛术后迟发性面瘫临床分析

目的 探讨微血管减压术治疗面肌痉挛所发生的术后迟发性面瘫的病因、预防及处理措施.方法 回顾性分析潍坊医学院附属医院及清华大学玉泉医院微血管减压术治疗面肌痉挛716 例术后出现迟发性面瘫的情况.结果 术后出现迟发面瘫31 例,其中Ⅱ级8 例,Ⅲ级17 例,Ⅳ级5 例,Ⅴ级1 例.随访1 ～4 个月,平均2.5 个月,痊愈25 例,好转5 例,无明显变化1 例.结论 产生迟发性面瘫的原因很多,以血管因素和手术操作为主要原因,但预后较好.一旦出现迟发性面瘫,早期积极处理可望获得良好结果.     

The effectiveness and safety of neurosurgical treatment via retrosigmoid approach in elderly patients with trigeminal neuralgia

ObjectiveThe purpose of this study was to evaluate the effectiveness and safety of retrosigmoid approach in treating older patients with trigeminal neuralgia (TN).MethodsIn this retrospective study, 49patients (65 and over, elderly group) and 85 patients (under 65, young group) underwent MVD, MVD + PSR or PSR for idiopathic TN from July 2009 to December 2018. The two groups were compared for immediate, long-term pain outcome and postoperative complications. All perioperative data were collected from medical records and telephone interviews. The pain outcomes were assessed with the Barrow Neurological Institute (BNI) pain score.ResultsThe length of follow-up was 13.2 to 124.8 months. 91.8% of the elderly patients and 89.4% of the young patients achieve “Good” immediate pain outcome (BNI I-II), the proportion were 73.5% and 60.0%, respectively, in long-term pain outcome. No statistically significant differences existed in the immediate and long-term pain outcome between the elderly and young patients (P = 0.768 and P = 0.116, respectively). In the grouping analysis, whether in the pure MVD group or the PSR-related group, the immediate and long-term pain outcomes of elderly patients were not significantly different from those of younger patients. Meanwhile, there was no significant difference in the incidence of neurological and non-neurological complications between two groups.ConclusionsCompared with young patients, the treatment for TN in elderly patients via retrosigmoid approach has the same favorable pain outcome. The safety of this procedure for elderly TN patients is similar to that in young patients.     

Endoscopic assistance in microvascular decompression of cranial nerves

Microvascular decompression (MVD) is an effective method for treatment of trigeminal neuralgia (TN), hemifacial spasm (HFS), glossopharyngeal neuralgia (GPN). The aim of this study was to assess the role of endoscopic assistance in MVD for the treatment of cranial neuropathies. Since 2009 till 2011 133 patients with cranial neuropathies were treated by MVD in Burdenko Neurosurgical Institute, Moscow. In 22 patients (11 patients with HFS, 10 patients with TN, 1 with GPN) endoscopic assistance was applied during the MVD. We used minimally invasive retrosigmoid approach in a unilateral position. Cerebellopontine angle was explored by 30-degree or 70-degree telescope to visualize the root entry zone of trigeminal, facial or glossopharyngeal nerves and to locate the neurovascular conflict. In 9 patients with HFS and in 1 patient with TN and in another patient with GPN endoscopy discovered offending vessels that were not visible through the microscope. In all cases endoscope was used to exclude another site of compression and to verify decompression and to identify position of teflon and offending vessel after MVD. Immediately after the surgery excellent outcome was observed in 10 patients with HFS (89%), one patient was reoperated 1.5 years after first operation with positive effect. Relief of pain in early postoperative period was observed in patients with TN and GPN. There were no major complications and postoperative mortality in our series. Endoscopic assistance is very effective and helpful technique in MVD of cranial nerves, especially in cases with HFS. In this study the use of the endoscope allowed to identify the site of compression and to confirm the position of teflon after MVD.