Efficacy of endoscope in microvascular decompression surgery for hemifacial spasm: Report of 2 cases

Since its first introduction in 1962, microvascular decompression (MVD) for hemifacial spasm (HFS) has continuously evolved. Traditionally, MVD has been performed under a surgical microscope, achieving symptom resolution rates between 88.5% and 90.5% by meta-analysis. With advancements in endoscopic technology, endoscope-assisted MVD technique was first introduced in 2002. Since then, it has been increasingly incorporated into MVD procedures, demonstrating success rates of 93.3% to 97% comparable to those of traditional MVD. Despite these promising results, the role of endoscope in MVD remains controversial due to its specific advantages and limitations. In this report, we present two cases of endoscope-assisted MVD for HFS performed by a single surgeon. In both cases, the endoscope provided critical assistance by enhancing visualization of the root exit zone, adjacent neurovascular structures, and offending vessels. Our experience demonstrates the value of endoscope in MVD not only for achieving effective decompression, but also for facilitating a clear comprehension of anatomical orientation, especially for less experienced surgeons.