Microvascular Decompression (MVD) for Trigeminal Neuralgia (TN)
What is Microvascular Decompression (MVD)?
MVD is a surgical procedure to relieve pain in the face caused by compression of a nerve by an artery or vein. It is performed to treat trigeminal neuralgia (TN), hemifacial spasm, and glossopharyngeal neuralgia. There are many surgical options for treating trigeminal neuralgia, but MVD is often considered the first-line approach because it restores the normal anatomy, without creating permanent numbness of the face. Medications often provide relief to patients with TN, but when medications become ineffective or cause serious side effects, one treatment option is MVD.
What is the goal?
The purpose of microvascular decompression is to relieve pressure from vessels that are pressing against the trigeminal nerve, that cause painful impulses in the face. To treat trigeminal neuralgia, a small sponge is placed between the trigeminal nerve and the blood vessels pushing on it.
What happens before surgery?
You will receive paperwork from Dr. Lad’s office and from the Department of Surgery with instructions and reminders regarding preparation to make before you have surgery. You will also have pre-anesthesia testing to make sure you are healthy enough to undergo the surgery. The anesthesiologist caring for you on the day of surgery may meet with you to review your medical history and answer any questions you may have. Dr. Lad will also visit you before the surgery to review the procedure and complete any necessary evaluations.
What happens during surgery?
A nurse will place an IV line in your arm and then transport you to the operating room. Microvascular decompression requires general anesthesia which means this is done in the operating room with you completely asleep and the anesthesiologist monitoring you throughout the operation. You will be placed in a Mayfield head clamp and there will be small incisions in the temple area. A small incision will be made behind the ear on the same side as the trigeminal neuralgia pain. The incision is carried down through the skin and a very small hole (quarter size) is made as a window to approach this blood vessel. A lumbar drain is placed in your back to help the surgeon see the anatomy more clearly. The covering of the brain, called the dura, is opened, and medications are usually given to allow the brain to relax so that the surgeon can work through a very small angle under microscopic magnification to expose the nerve. In addition, the nerves are continuously monitored throughout the procedure to perform it as safely as possible, including the nerves controlling strength and hearing. Once the nerve is exposed and particularly when its entrance to the brain stem is seen, a careful inspection is done for vascular compression. After detecting the vascular compression, the surgeon will elevate the blood vessel off of the nerve and place a small pad of Teflon. The Teflon material is synthetic and is easily placed between the nerve and the vessel. This creates a partition between the nerve and the vessel so that the vessel no longer pulsates on the nerve. Closure is done by suturing the dura and placing a synthetic material to cover the hole made in the bone. Upon completion, there is no defect in the bone and the incision will heal very nicely.
This is an illustration showing how you will be positioned during surgery (Mayfield clamp) and the location of the incision behind the ear.
This is a picture of the titanium plate that will be used to cover the hole made in the bone. It is approximately the size of a quarter.
What happens after Surgery?
Once the surgery is complete, you will be transferred to the recovery room. You will be closely monitored here by your anesthesiologist and specially trained nurses. Dr. Lad will then explain how the surgery went to your family in the waiting room and you will be transferred to the Neurosciences Intensive Care Unit.
Usually you will spend one night in the Neurosciences Intensive Care Unit with mobilization the following day out of ICU to a regular private room. On the first day after surgery, you will usually be allowed to get out of bed and have breakfast. The dressing will not be changed for three days. On the second or third day, the patient is discharged after dressing change and the lumbar drain is pulled.
How do I take care of myself after surgery?
You will receive post-operative information from Dr. Lad’s office and from the Department of Surgery.
You will need to continue all preoperative pain medication. These will be slowly decreased by the physician who started them. Staples/sutures are removed 10 to 14 days after surgery. Most patients may also experience muffled hearing on the side of surgery, facial numbness, fatigue from anesthesia, nausea/vomiting in the hospital (meds will be given) which usually improves over time. You may not drive or go back to work for about one month. You cannot wear wigs, use hair dye or other harsh products for 6 months. These will interfere in long term healing and may cause infection which could require further surgery.
What are the risks of surgery?
Microvascular decompression is an invasive procedure, and while safe in expert hands, does have potential rare/infrequent risks, including:
Severe headache not relieved by medication
Hearing loss, facial numbness, and/or facial weakness (usually temporary, rarely permanent)
Cerebrospinal fluid leak
Difficulty with speech or swallowing
Stroke or hemorrhage (very rare)
If at any time following your surgery you notice:
Redness, swelling, drainage or foul odor from the surgical site
Increase in pain at the surgical site
Fever of 101⁰F or higher with any of the above symptoms
CALL THE OFFICE IMMEDIATELY OR, IF AFTER HOURS, PAGE THE OPERATOR TO SPEAK TO THE NEUROSURGEON ON CALL AT 919-681-8111