Microvascular decompression of the trigeminal nerve

What is Microvascular Decompression and Why is it Done?

Microvascular decompression (MVD) is a surgery to treat hemifacial spasm, a condition causing involuntary muscle twitching or spasms on one side of the face. These spasms are often due to a blood vessel pressing on the facial nerve (the nerve controlling facial muscles) near the brainstem. MVD aims to separate the blood vessel from the nerve, stopping the spasms while preserving normal facial movement.

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 spasms. 
• Accessing the Nerve: A small opening is made in the skull (craniotomy) to reach the facial nerve near the brainstem. The surgeon uses a microscope and specialized tools for precision. 
• Decompression: The blood vessel pressing on the facial 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 2-4 hours, and patients typically stay in the hospital for 2-5 days.

Benefits of Microvascular Decompression

• Effective Relief: MVD can stop hemifacial spasms for many patients, often providing long-lasting or permanent relief. 
• Preserves Nerve Function: The surgery aims to protect the facial nerve, maintaining normal facial movement and sensation. 
• Minimally Invasive Techniques: The small incision and precise approach reduce recovery time compared to older methods. 
• High Success Rate: MVD is the most effective surgical treatment for hemifacial spasm 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 facial nerve or nearby structures may be affected, causing temporary or permanent facial weakness, numbness, or hearing loss on the affected side. 
• Cerebrospinal Fluid Leak: Fluid from around the brain may leak, requiring treatment. 
• Recurrence of Spasms: Spasms 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 hemifacial spasm caused by a blood vessel pressing on the facial nerve, confirmed by imaging (like an MRI), and your symptoms significantly affect your quality of life or don’t respond to non-surgical treatments. MVD is often recommended for patients who are healthy enough for a minor brain surgery, but 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 hemifacial spasm, offering the potential for long-term relief without damaging the facial nerve. If you’re considering this surgery, talk to your Neurosurgeon about your symptoms, treatment options, and any questions to make an informed decision.