Microvascular decompression (MVD) is a surgical procedure performed to relieve the pressure on a compressed nerve caused by a vein or artery.
The abnormal compression of a cranial nerve can cause trigeminal neuralgia (TN), glossopharyngeal neuralgia, or hemifacial spasm. All of which can be treated with the help of MVD.
The pain associated with trigeminal neuralgia is severe and debilitating. There have been reports of patients committing suicide published in the literature.
Initially, doctors use pain medications to provide relief to patients with trigeminal neuralgia. If the pain persists or there are side effects from the medication, the doctor will consider the patient for MVC surgery.
A suitable candidate for MVD would be:
This surgery involves opening the skull also known as a craniotomy. An opening is made in the skull and the dura, which is a membrane covering the brain. This way surgeons can access the Trigeminal Nerve.
The neurosurgeon then inserts a Teflon sponge between the nerve and the artery triggering the pain signals. He or she will use a high magnification microscope, neuronavigation and facial nerve monitoring during the procedure.
The patient will need to consult their primary care physician about stopping some specific medications. Included in this is the use of nicotine and drinking alcohol. The patient should consuming these substances 1 week prior to and 2 weeks post-surgery. This is to avoid bleeding and healing issues.
The doctor will conduct some medical examinations. These may include:
The doctor may ask the patient to wash their hair and skin with antiseptic hair wash to reduce the chance of infection.
The doctors will also ask the patient to not eat or drink anything after midnight before surgery. Permitted medicines can be taken with a small sip of water.
The operation generally takes 2 to 3 hours. The procedure is done using general anaesthesia.
The hairs behind the ear are shaved and a small part of the skull is removed. After the nerve is identified, the surgeon places suitably sized pieces of Teflon between the nerve and the offending blood vessel. The piece of bone that was removed if fixed back with titanium plates.
Most patients are discharged from the hospital 2 nights post-surgery. It is important that the patient follows their surgeon’s home care instructions for 2 weeks post-surgery or until their follow-up appointment.
Patients can expect some restrictions in physical activities initially. All strenuous activities including housework and sex would be restricted too.
The patient should avoid smoking as it may delay healing.
The patient should also avoid drinking alcohol. This may increase their risk of bleeding and can interact negatively with the pain medicine.
Until the surgeon gives a go-ahead, the patient is not expected to not drive, return to work, or fly in air travel.
The doctor will advise the patient on how to care for the incision area. Some general guidelines:
Your surgeon will advise pain relief medication for headaches which are common post-surgery.
The patient should take all pain medicines as advised by the surgeon. As pain subsides they can reduce the amount and frequency of administration.
Doctors will also prescribe any medicines to manage the side effects of the medications prescribed post-surgery. This can include laxatives and stool softeners.
It is important to call a doctor if the patient experiences any side effects such as drowsiness or balance problems.
The patient should not take any medicines without the doctor’s approval.
Doctors recommend walking 5-10 minutes every 3-4 hours. This can gradually be increased when the patient is able.
It is recommended that the patient elevate the head position when sleeping.
MVD surgery is an invasive procedure. Some potential but rare risks include:
MVD is highly successful in treating trigeminal neuralgia. Approximately 90% of patients will have rapid relief from trigeminal neuralgia. There is a relatively low risk (20%) of pain recurrence within 10 years. MVD causes little or no facial numbness when compared to percutaneous stereotactic rhizotomy (PSR).
Preoperative pain medication will be gradually decreased after a month by the physician.
Firstly, ancillary tests are used to rule out other possible diagnoses. Such tests include dental examinations, MRI, blood tests, and reflex tests.
Trigeminal neuralgia is diagnosed based on clinical presentation. This is confirmed with MRI scans which look for blood vessel loops or other structures compressing on the nerve.
Other options of treatment are radiofrequency ablation and glycerol injections. The treating doctor will decide on the best possible option after taking into consideration all patient and radiological factors.
Surgery is not recommended for: