Operative Neurosurgery 30:870–879, 2026
This clinical case series reports outcomes of 204 patients who underwent fully endoscopic microvascular decompression (MVD) for hemifacial spasm (HFS), comparing 2D and preliminary 3D endoscopic techniques and analyzing learning-curve effects. Detailed methods, operative technique, intraoperative monitoring (LSR), and complication rates are presented alongside imaging and intraoperative findings.
Results show a 97.1% overall effectiveness with low long-term complication rates and improving outcomes over time; the 3D endoscope afforded improved stereoscopic perception though with higher cost and minor drawbacks, and the authors recommend further study of 3D endoscopy in MVD.
Study scope Retrospective analysis of 204 hemifacial spasm patients treated with fully endoscopic microvascular decompression using 2D (191) or 3D (13) endoscopy (July 2017–Oct 2024); mean follow-up 20.4 months.
Surgical approach Procedures used a retrosigmoid infrafloccular route with LSR monitoring; polytetrafluoroethylene (Teflon) pledgets placed between facial nerve REZ and offending vessels, with further exploration if LSR persisted.
Effectiveness At last follow-up, 198/204 (97.1%) had cessation or significant reduction of spasms (excellent 86.8%, good 10.3%).
Complications Immediate postoperative complications included facial weakness (7), hearing loss (11), tinnitus (1), infection (1), dysphagia (1), and CSF leak (1); 10 patients had persistent complications at last follow-up (6 hearing loss, 3 facial weakness, 1 tinnitus).
Learning curve Outcomes improved over time: effectiveness 95.6% → 97.1% → 98.5% (early/middle/late), while complication rates decreased 5.9% → 5.9% → 2.9%.
Offending vessels Most common offending vessel was AICA (43.1%), with multiple vessels in 33.3% of cases (including combinations with VA and PICA).
3D endoscopy pros/cons 3D endoscope provided subjectively better stereoscopic vision/depth perception aiding surgery, but had drawbacks including slight vertigo and high cost.
Overall conclusion Fully endoscopic MVD offers wide visualization of the neurovascular conflict region and helps minimize brain injury from retraction; favorable outcomes and low complications once technical proficiency is achieved, with more research needed on 3D’s role.
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