Hybrid Microvascular Decompression For Cranial Neurovascular Compression Syndromes: A Retrospective Case Series and Surgical Nuances.

BACKGROUND: Microvascular decompression (MVD) remains the gold standard for the treatment of neurovascular compression syndromes (NVCS). Adjunctive visualization tools have been introduced to improve visualization beyond the direct microscopic line-of-sight. This study evaluated the technical feasibility, safety, and short- to mid-term clinical outcomes of QEVO®-assisted microscopic MVD. METHODS: This retrospective series included 43 patients who underwent QEVO®-assisted MVD for trigeminal neuralgia (TN, 31), hemifacial spasm (HFS, 11), and cochleo-vestibular nerve compression syndrome (1) between January 2021 and September 2024 at ASST Cremona (Italy). The study was designed as a descriptive case series without a control group. A "microscopically hidden" NVC was defined when was not identified during standard microscopic inspection, became apparent following QEVO® inspection, and prompted additional microscopic arachnoid dissection and/or vessel mobilization. RESULTS: No QEVO®-related adverse events occurred during surgery. QEVO® facilitated the identification of "hidden" NVCs in four patients (13%) with TN and one (9%) with HFS. All "hidden" NVCs in TN exhibited a "mixed" compression pattern on the anterior aspect of the trigeminal root entry zone (REZ). The "hidden" NVC identified in HFS consisted of a "tandem" compression pattern at the facial REZ. At the last follow-up, 84% of patients with TN achieved a Barrow Neurological Institute pain score grade I or II, while all patients with HFS reached complete symptom resolution. CONCLUSIONS: QEVO® proved to be a feasible adjunctive visualization tool that can be integrated into the standard microscopic workflow, facilitating the identification of additional neurovascular relationships particularly in patients with complex NVC patterns.