To Maximize the Advantage of the Uprising Visualization System: Modified Retro-Sigmoidal Approach for Purely Endoscopic MVD Surgery for HFS

Author(s): Chongjing Sun, Puyuan Zhao, Chenghui Qu, Jin Xu, Xiaobiao Zhang, Wei Zhu, Yu Zhang

Aim: The number of reports on endoscopic MVD for HFS has been growing swiftly. However, the majority of the literature has been focusing on the advantage of endoscope and the comparison between endoscope and microscope. Little was mentioned to modify the surgical approach to promote the use of endoscope. In order to maximize the advantage of endoscope, we present a series of HFS cases treated with MVD, using a retro-sigmoidal approach that is specially modified for purely endoscopic surgeries.

Method: 86 consecutive cases with primary HFS treated by our team with purely endoscopic MVD were retrospectively included in this study. During surgery, the patient’s head remained in a horizontal position without rotation for a face-down tendency and the vertex of the head was only slightly tilt towards the floor. Angled endoscopes were used for better view and more manipulating space.

Results: Of all the 86 patients, the symptom of 67 cases (77.9%) was released immediately after operation and in 15 (17.4%) cases there was a delayed relief. Post-operative neck and shoulder pain, mild transient hearing loss and transient facial paralysis were reported in 5 (5.8%), 3 (3.5%) and 2 cases (2.3%) respectively.

Conclusion: The modification of the retro-sigmoidal approach in order to facilitate the application of endoscope improved the intra-operative exposure and space for manipulation, and reduced the post-operative discomfort of the patients. Purely endoscopic MVD surgery is a safe and effective treatment for HFS.