Microvascular Decompression (MVD) for Trigeminal Neuralgia

What is Microvascular Decompression and Why is it Done?

Microvascular decompression (MVD) is a surgery to relieve trigeminal neuralgia, a condition causing severe, electric-shock-like facial pain due to pressure on the trigeminal nerve (a nerve responsible for facial sensation). This pressure often comes from a blood vessel pressing against the nerve near the brainstem. MVD aims to separate the blood vessel from the nerve, reducing or eliminating the pain while preserving normal facial sensation.

How is the Surgery Performed?

• Anesthesia: You’ll be under general anesthesia, so you’ll be asleep and feel no pain during the procedure. 
• Incision: The surgeon makes a small incision (about 1-2 inches) behind your ear on the side of the pain. 
• Accessing the Nerve: A small opening is made in the skull (craniotomy) to reach the trigeminal nerve near the brainstem. The surgeon uses a microscope and specialized tools for precision. 
• Decompression: The blood vessel pressing on the trigeminal nerve is carefully moved away, and a small, soft pad (often made of Teflon) is placed between the nerve and vessel to prevent further contact. 
• Closing: The skull opening is closed with a bone flap or small plate or bone substitute, and the incision is stitched, leaving a small scar that typically fades over time.

The procedure usually takes 1-2 hours, and patients typically stay in the hospital for 2-3 days.

Benefits of Microvascular Decompression

• Effective Pain Relief: MVD offers long-lasting pain relief for many patients, often eliminating trigeminal neuralgia symptoms. 
• Preserves Nerve Function: The surgery aims to protect the trigeminal nerve, maintaining normal facial sensation. 
• Minimally Invasive Techniques: The small incision and precise approach reduce recovery time compared to older methods. 
• High Success Rate: MVD is considered the most effective surgical option for trigeminal neuralgia caused by vascular compression.

Possible Risks and Complications

While MVD is generally safe, all surgeries carry some risks, including: 

• Nerve or Brain Issues: Rarely, the trigeminal nerve or nearby structures may be affected, causing temporary or permanent numbness, weakness, or hearing loss on the affected side. 
• Cerebrospinal Fluid Leak: Fluid from around the brain may leak, requiring treatment. 
• Recurrence of Pain: Pain may return if the nerve is compressed again or if another cause is involved. 
• General Surgery Risks: These include infection, bleeding, blood clots, stroke, or reactions to anesthesia.

Following your surgeon’s pre- and post-surgery instructions can help minimize these risks. Discuss all potential risks with your surgeon to understand what to expect.

Who is a Candidate for Microvascular Decompression?

You may be a candidate if you have a typical trigeminal neuralgia caused by a blood vessel pressing on the trigeminal nerve, confirmed by imaging (MRI) and medical treatment is either inefective, causing side effects or patient is willing to live medication free. Sometimes MRI scan is negative to confirm vessel pressing on the nerve, in such situations, if there is a typical clinical presentation, surgery may still be indicated as most times vessel pressing on the nerve is found during the surgery. Your surgeon will evaluate your condition through a physical exam, imaging, and a discussion of your symptoms to determine if this procedure is right for you.

Talk to Your Surgeon

Microvascular decompression is a highly effective option for many patients with trigeminal neuralgia, offering the potential for long-term pain relief without damaging the nerve. If you’re considering this surgery, talk to your Neurosurgeon about your symptoms, treatment options, and any questions to make an informed decision.