Research Article 12 Volume 7 • Issue 1 To Maximize the Advantage of the Uprising Visualization System: Modifed Retro-Sigmoidal Approach for Purely Endoscopic MVD Surgery for HFS Chongjing Sun 1 , Puyuan Zhao 1 , Chenghui Qu 2 , Jin Xu 1 , Xiaobiao Zhang 1 , Wei Zhu 1 *, Yu Zhang 1 * Afliation: 1 Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China 2 Department of Anesthesiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China *Corresponding author: Wei Zhu and Yu Zhang. Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China. Citation: Chongjing Sun, Puyuan Zhao, Chenghui Qu, Jin Xu, Xiaobiao Zhang, Wei Zhu, Yu Zhang. Modifed Retro-Sigmoidal Approach for Purely Endoscopic MVD Surgery for HFS. Journal of Psychiatry and Psychiatric Disorders 7 (2023): 12-16. Received: January 17, 2023 Accepted: January 27, 2023 Published: February 03, 2023 Keywords: Modifed approach; Retro-sigmoidal approach; Endoscope; Microvascular decompression; Hemifacial spasm Introduction Hemifacial Spasm (HFS) is a facial movement disorder, featured by involuntary and unilateral spasm of muscles innervated by facial nerve. It is caused by vascular compression on the Root Entrance Zone (REZ) of the facial nerve. A procedure aiming to identify the ofending vessels and remove them from the facial nerve was invented by Jannetta. The procedure was named Microvascular Decompression (MVD) and has been established as the only cure for HFS. Traditionally the procedure was carried out under a surgical microscope. Following its robust development in the past two decades, neuro-endoscope, as a visualization system, has participated in many aspects of neurosurgery. Abstract 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 modifed 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 foor. 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 modifcation 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 efective treatment for HFS.