Microvascular decompression (MVD) is a surgical procedure designed to alleviate intense facial pain. Its primary goal is to relieve pressure on the trigeminal nerve, a major nerve responsible for facial sensation, by carefully separating a blood vessel pressing against it. MVD is typically considered when other treatments, such as medication, have not provided sufficient relief for individuals experiencing this debilitating condition.
Understanding Trigeminal Neuralgia
Microvascular decompression primarily treats trigeminal neuralgia (TN), a chronic pain condition characterized by sudden, severe, and shock-like facial pain. This pain often feels like an electric shock or stabbing sensation. The pain typically affects one side of the face and can occur in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, and occasionally the eye and forehead. Episodes can last from a few seconds to several minutes, and while some individuals experience periods without pain, the attacks often become more frequent and intense over time.
The most common underlying cause for which MVD is performed is the compression of the trigeminal nerve by an artery or vein. This contact puts pressure on the nerve, preventing it from functioning normally. The constant pulsation of the blood vessel against the nerve can wear away its protective outer layer, called the myelin sheath, making the nerve highly sensitive and causing it to misfire and generate pain signals. While vascular compression is the most frequent cause, TN can also result from conditions like multiple sclerosis, tumors, cysts, or facial trauma.
The Microvascular Decompression Procedure
Microvascular decompression surgery typically begins with the patient under general anesthesia. The surgeon makes a small incision behind the ear on the side of the head where the patient experiences pain. A small opening, known as a craniotomy, is then made in the skull to access the brain.
Using an operating microscope and specialized tiny instruments, the surgeon locates the trigeminal nerve at its origin with the brainstem. The offending blood vessel, which is often the superior cerebellar artery or a branch of the petrosal vein, is then identified pressing against the nerve. The surgeon gently moves the blood vessel away and places a small, non-absorbable cushion, commonly made of Teflon felt, between them. This cushion acts as a barrier, relieving pressure on the nerve without damaging it. The entire procedure typically takes between 2 to 4 hours.
Preparing for and Recovering From Surgery
Patients prepare for microvascular decompression by signing consent forms and providing their medical history, including allergies, current medications, and any reactions to anesthesia. Pre-surgical tests, such as blood tests, electrocardiograms, and chest X-rays, may be conducted a few days before the surgery. Patients are usually advised to stop taking non-steroidal anti-inflammatory medicines and blood thinners approximately 7 days before the procedure, and to avoid nicotine and alcohol for at least a week prior.
On the day of surgery, patients are admitted to the hospital, and a nurse confirms details and explains the pre-operative process. The anesthesiologist discusses the effects and risks of general anesthesia. After surgery, patients are taken to a recovery room where vital signs are closely monitored as they awaken. Many are then transferred to an intensive care unit (ICU) for overnight observation.
Immediate post-operative experiences include pain at the incision site and headaches, managed with medication. Nausea is also a common, temporary symptom that can be treated. The typical hospital stay after MVD is 1 to 3 days, with discharge instructions provided upon release. During initial weeks at home, patients may feel tired and experience mild headaches, and activity restrictions, such as avoiding heavy lifting for about 6 weeks, are generally advised.
What to Expect After Microvascular Decompression
Following microvascular decompression, many patients experience significant pain relief, often immediately after the procedure. The success rates for MVD are generally favorable, with approximately 80% to 90% of patients reporting initial pain relief. Long-term pain freedom, without medication, is reported by about 73% to 80% of patients after one year and can range from 58% to 68% after 8 to 10 years. While a majority achieve substantial relief, some individuals may have residual mild symptoms or experience a recurrence of pain, which might necessitate additional management.
Common post-operative sensations can include facial numbness or tingling, which often resolve within about a week. Some patients may also experience changes in hearing, although this complication is less common, occurring in a small percentage of cases, around 0.2% to 4.5%. Follow-up appointments with the surgeon are important to monitor recovery progress and address any lingering concerns. The full resolution of symptoms can sometimes take days or weeks, particularly for those who have experienced pain for an extended period.