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Trigeminal neuralgia is a nerve dysfunction that causes excruciatingly painful and often debilitating symptoms. In most cases, your doctor will start with medications to see if the symptoms are abated that way. While medications work for some individuals, you may have found that they either don’t provide adequate relief or the side effects far outweigh the benefits. On the upside, there are numerous other treatments available, including microvascular decompression surgery (MVD).

What Is Trigeminal Neuralgia?

Considered one of the most painful nerve disorders, trigeminal neuralgia is a condition in which the outer coating (myelin) of the trigeminal nerve is either damaged or is being compressed by another structure. The former can happen through some diseases or trauma, while the latter is caused by an adjacent blood vessel pressing against the trigeminal nerve. In both scenarios, the symptoms are the same — flashes or spurts of pain that have been described as intense electric shock like pain that occurs on one side of the face. They can happen occasionally or daily.

Microvascular Decompression Surgery for Trigeminal Neuralgia

Microvascular decompression surgery is an intracranial procedure that has changed the face of trigeminal neuralgia for thousands of patients. While it is not an ideal procedure for everyone that suffers from this condition, it may be the right solution for you.

MVD addresses the problem of nerve impingement brought about by a blood vessel such as an artery pressing against your trigeminal nerve. The constant pulsing of blood through the vein or artery creates a great deal of irritation, causing the trigeminal nerve to become inflamed and “misfire.”

Microvascular decompression surgery usually can’t help in cases where the nerve is damaged, but it can make a big difference when nerve compression is taking place. In order for your doctor to determine whether you’re an ideal candidate for MVD, you’ll need to be in good health. If that is the case, you’ll then be referred to have a FIESTA MRI. This is a special imaging study that allows your doctor and radiologists to pinpoint whether or not your trigeminal neuralgia is being caused by a blood vessel pressing on your trigeminal nerve. If it’s found this is the case, then you’re likely a great candidate to undergo an MVD surgery.

What to Expect With MVD Surgery

Once you’ve decided to have microvascular decompression surgery it’s time to start preparing. Having everything in place and knowing what to expect for every phase of the surgery and recovery will give you peace of mind and allow you to spend your recovery time doing just that.

Preoperative Preparation

Schedule your surgery for a date that will give you plenty of time to recover. Although recovery times are shorter than those associated with other intracranial procedures, you’ll still need to be able to rest and heal properly. Arrange for help during your recovery period — be it a family member or someone you hire to assist you with your daily routine. If there is paperwork you can fill out ahead of time, go ahead and get it prepared. This will save you a great deal of time and stress the day of your surgery.

Day of Surgery

On the day of surgery, show up at the hospital well ahead of your operation time. This ensures that you can be properly prepared and fill out any last-minute paperwork. You will meet briefly with your anesthesiologist and then be prepped for surgery.

In the Operating Room

Once you’ve been taken to the operating room you will be sedated and may already be asleep. Your surgical team will prepare the surgical site at the base of your skull. Your surgeon will make a small incision in the skin and then remove a portion of bone about the size of a quarter from your skull. This tiny “window” will allow him or her access to the nerves and blood vessels. Using an operative microscope, your surgeon will find the trigeminal nerve and the blood vessel that is pressing against it. A small Teflon cushion will be placed between the nerve and artery or vein. This will absorb the impact of the pulsing blood vessel and prevent contact between the two structures.

Once it is established that the cushion is in the right place, your surgical team will test and monitor facial responsiveness before closing both the window in the bone and the incision in your skin. MVD surgery typically takes about 2–3 hours from start to finish. You will be moved to a recovery area where you will awaken from anesthesia. When it’s determined you’re stable, you will be transferred to ICU (intensive care unit) for observation during the first 24 hours of your recovery.

Your Postsurgical Hospital Stay

During your first 24 hours in the ICU, you will be carefully monitored. Pain relief medications will be adjusted to maximize comfort, and vitals will be regularly checked. Typically after one day you will be cleared to move to a regular room. Two to three days is the average hospital stay for MVD surgery.

Going Home: The Weeks Following Surgery

One to two weeks after you’ve gone home you can expect to return to your doctor’s office. At this visit, you will be assessed and your incision checked for redness or swelling (an indication of infection). You may still be experiencing some slight numbness or pain in your face but nothing near the levels prior to surgery.

In the first week, you can start to increase your activity level by going for short, gentle strolls, or doing light housework or other minimally exerting activities.

By the third week, you will be able to return to your normal activities as long as they are not strenuous or high-intensity in nature. At this point, you should be almost (if not completely) free of facial pain. You can expect to see your doctor again to ensure everything is moving along as planned in your recovery.

If your job is light or sedentary, you may be able to return to work. Any job that requires a high level of intense activity or heavy lifting will require a few more weeks of recovery to ensure you don’t injure the surgical area.

Working closely with your trigeminal neuralgia surgeon, you will be able to gradually resume all of your normal activities within a reasonable timeline. Regaining your life and your freedom from trigeminal neuralgia is possible with the help of a seasoned, compassionate and knowledgeable neurosurgeon providing guidance and treatment.
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