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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.

Who is the ideal candidate for this surgery?

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:

  • Someone with uncontrolled trigeminal neuralgia despite medication. Ideally they have minimal to no facial numbness associated with other treatments (glycerol injection or percutaneous stereotactic radiofrequency rhizotomy).
  • Someone with facial pain with dedicated scans showing compression of nerves by loops of blood vessels.
  • Someone with facial pain recurrence after a percutaneous or radiosurgery procedure.
  • As MVD involves the use of general anaesthesia, it is not a suitable treatment option for patients with other medical conditions or patients in poor health. 
  • MVD is not recommended for treating facial pain which is caused by multiple sclerosis.

The Procedure

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.

How to prepare for the surgery

Several days before the surgery

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:

  • a special MRI (“Trigeminal neuralgia protocol MRI”)
  • a special CT scan (“Brainlab CT”)
  • a hearing test (audiogram)
  • blood work
  • an ECG
  • baseline brain wave monitoring to monitor nerves at the time of surgery

Day of surgery

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.

What happens during the surgery

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.

What happens after the surgery

  • Most patients experience muffled hearing on the side where surgery was performedHearing noises such as popping, crackling, ringing from inside the head are part of normal healing, as air and fluid are reabsorbed.
  • The patient may experience facial numbness and nausea or vomiting while in the hospital. The treating physician will prescribe medication to alleviate these symptoms.
  • It is common to also experience fatigue due to the anaesthesia though this improves over time.
  • Doctors will remove sutures or staples 10 to 14 days post-surgery.
  • Bruising and swelling of the ear or face may occur and take several weeks to go away. Ice packs thrice a day for 15-20 minutes can help in relieving any swelling and pain.

Recovery from the procedure

Monitoring and discharge from hospital

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.

Incision Care

The doctor will advise the patient on how to care for the incision area. Some general guidelines:

  • Do not scrub the incision.
  • Do not submerge or soak the incision in a bath, tub, or pool.
  • Do not apply any lotion or ointment on the incision.
  • Avoid any hair colour for 6 weeks post-surgery. Use caution near the incision when getting a hair-cut.


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.

What are the risks of this surgery?

MVD surgery is an invasive procedure. Some potential but rare risks include:

  • Infection
  • Loss of hearing
  • Facial numbness and/or facial weakness, mostly temporary but can be permanent
  • A leak of spinal fluid
  • Difficulty with speech
  • Difficulty with swallowing
  • Stroke or haemorrhage, very rare

Outcomes of surgery

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.

Frequently asked questions

What are the tests that need to be done to confirm the diagnosis or trigeminal neuralgia or hemifacial spasm?

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.

Are there other techniques to help to control the pain of trigeminal neuralgia? 

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. 

What are the conditions where a patient with trigeminal neuralgia cannot have surgical treatment? 

Surgery is not recommended for:

  • patients who are categorised as higher surgical or anaesthetic risk
  • patients with other neurodegenerative conditions such as MS