3D-BRAVO combined with 3D-TOF sequence reconstruction before microvascular decompression can fully evaluate the morphology, location, and anatomical relationship of lesions, which is of guidance value for clinical diagnosis and treatment 1).
Microvascular decompression (MVD) for neurovascular compression syndromes, such as trigeminal neuralgia and hemifacial spasm, has been traditionally described as an interposing technique using Teflon. Some alternative interposing materials have been proposed. In addition, transposing techniques have been increasingly reported as an alternative with a potentially lower recurrence rate and fewer complications. 2).
Combined Hyperactive dysfunction syndrome (HDS) involves a group of functional disturbance disorders affecting specific cranial nerves, and may include TN, HFS, and GPN. In addition to gender and hypertension incidence, age appeared to be a vital parameter for developing combined HDS, although this finding was inconsistent in previous studies. MVD appears to be a safe and effective treatment for combined HDS, with a high rate of long-term success 3).
In a retrospective analysis of patients who have undergone Microvascular decompression by the trainee (07/2014-07/2017) and by the senior neurosurgeon (03/2011-04/2015). Data such as surgery time, length of stay, outcomes and complications were collected.
Out of the 18 cases of MVD were performed by the trainee, 10 were supervisor trainer unscrubbed (STU) or performed (P) and 8 were supervisor trainer scrubbed (STS). Mean surgical time was 2:30 hrs and mean length of stay was 6.33 days. The mean outcome score was 2.33/3 with 89% cases a positive outcome. The complication rate was 16.7%, of which one had meningitis, one had CSF leak and one developed a pseudomeningocele. The trainee's surgery time, outcomes and complication rates were comparable to trainer and the literature. There was a statistically significant correlation between number MVD performed and operative time (R = -0.50, p < .05), intervals between MVDs and complication rates (R = 0.64, p < .05), and interval between MVDs and outcome scores (R = -0.66, p < .05). Phang et al., estimate the time between cases should be below 40 days.
Training a trainee is safe and does not add much burden to the hospital. A trainee will benefit the most if they have the same supervisor at least for the first eight cases and that each case should be done within 40 days of each other 4).