How I do it: 3D exoscopic endoscope-assisted microvascular decompression

Background: Microvascular decompression (MVD) is an effective treatment for drug-resistant trigeminal neuralgia and hemifacial spasm. However, failure of symptomatic improvement can arise from difficulties in identifying and/or decompressing the offending vessel. Microscopic and endoscopic techniques have been used to improve visualisation and safety of the procedure but there are limitations to each technique. Method: A 3D exoscopic endoscope-assisted MVD technique is described, including advice on potential pitfalls. Conclusion: Compared with the standard microscope-assisted techniques, the 3D exoscopic endoscope-assisted MVD offers an improved visualisation without compromising the field of view within and outside the surgical field.