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Objective: To discuss the results of endoscope-assisted surgery in microvascular decompression (MVD) of Cranial Nerves (CNs) V, VII, and VIII., Methods: Neuroendoscopy was used as an adjunct to the surgical microscope in the MVD of the trigeminal (17 patients), facial (10 patients), and vestibulocochlear (1 patient) nerves in a series of 28 consecutive patients. After a standard microsurgical approach to CNs V, VII, and VIII, the endoscope was used to inspect all aspects of neural anatomy, to assess vascular compression, and to check the results of the decompression. Endoscope use was graded in four categories: Grade I, used but no definite role; Grade II, visualization assisted; Grade III, procedure assisted; and Grade IV, primary role. The usefulness of the endoscope was evaluated in each case., Results: The endoscope was useful in visualizing the anatomy in all cases. It was especially useful in establishing trigeminal vein compression of CN V in Meckel's cave; observing multiple sources of vascular compression; ensuring adequate decompression after cauterization of vein, insertion of the Teflon felt, or a pexy procedure; and permitting observation of the compression of CN VII at the root exit zone by small arteries and veins. In six patients with trigeminal neuralgia, the trigeminal vein was cauterized and divided by using endoscopic vision only because the venous compression was not completely visualized with the microscope. During a follow-up period of 6 to 52 months (mean, 29 mo; median, 40 mo), all patients were asymptomatic and receiving no medication., Conclusion: The endoscope is a useful adjunct to MVD in the treatment of trigeminal neuralgia, hemifacial spasm, and disabling positional vertigo or tinnitus.

Objective: We discuss the role of the endoscope in the microsurgical treatment of intracranial aneurysms, analyzing its benefits, risks, and disadvantages., Methods: This was a prospective study of 55 patients with 79 aneurysms, treated between July 1998 and June 2001, for whom the endoscope was used as an adjunct in the microsurgical treatment of their lesions. Seventy-one aneurysms were located in the anterior circulation, and eight were located in the posterior circulation. Thirty-seven patients presented with subarachnoid hemorrhage. Eighteen patients had unruptured aneurysms, of whom 5 presented with mass effect, 2 presented with transient ischemic attacks, and 11 were without symptoms. In all cases, the endoscope was used in addition to microsurgical dissection and clipping (sometimes before clipping, sometimes during clipping, and always after clipping), for observation of the neck anatomic features and perforators and verification of the optimal clip position. Intraoperative angiography was performed for all patients after aneurysm clipping., Results: In the majority of cases, the endoscope was very useful for the assessment of regional anatomic features. It allowed better observation of anatomic features, compared with the microscope, for 26 aneurysms; in 15 cases, pertinent anatomic information could be obtained only with the endoscope. The duration of temporary clipping of the parent artery was significantly reduced for two patients. The clip was repositioned because of a residual neck or inclusion of the parent vessel during aneurysm clipping in six cases, and the clip position was readjusted because of compression of the optic nerve in one case. One patient experienced a small aneurysm rupture that was directly related to use of the endoscope, but this was easily controlled, with no sequelae. For many patients, the combination of the neuro-endoscope and the micro-Doppler probe made intraoperative angiography redundant., Conclusion: "Endoscope-assisted microsurgery" is a major advance in the microsurgical treatment of intracranial aneurysms; the endoscope allows better observation of regional anatomic features because of its magnification, illumination, and ability to "look around corners."