Introduction HFS primarily attributed to neurovascular compression at the root exit zone (REZ) of the CNVII, presents significant challenges in diagnosis and management. While Microscopic MVD remains gold standard treatment, its efficacy in cases involving vertebrobasilar dolichoectasia (VBD) is less explored.

Aim of Study This systematic review aims to evaluate the safety and efficacy of endoscopic-assisted MVD (E-MVD) specifically in HFS secondary to VBD.

Methods A comprehensive search done using MeSH keywords ‘Endoscopic’, ‘Microvascular Decompression’, ‘Vertebral Artery’, ‘Hemifacial spasm’, across multiple databases. Following PRISMA guidelines we identified six studies comprising 69 patients.

Results Mean age was 53.63 years with female predominance. E-MVD demonstrated an 84.06% complete resolution rate, with partial resolution in 8.70% and no relief in 7.25% of cases. Transient facial palsy was the primary postoperative complication. Following factors poses increased risk for comorbidities/post-operative complications: age ≥ 60 years old (4.2500), male (1.1905), AICA involvement (3.7037) and left sided involvement (1.5750).

Comparison with traditional microscopic MVD reveals comparable success rates, with E-MVD offering enhanced visualization and potential reductions in complications. Challenges related to vertebral artery involvement and complex compression patterns are addressed more effectively with endoscopic techniques.

Conclusion E-MVD presents a promising alternative for managing HFS secondary to VBD, offering high success rates and potential reductions in complications compared to traditional approaches. Continued research efforts and surgeon training are essential to optimize outcomes and refine techniques in the evolving field of endoscopic neurosurgery.

Disclosure of Interest no.