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Trigeminal neuralgia is one of the most painful conditions a person can have. Unfortunately, it’s also tricky to manage. If you and your neurologist have reached the point where medical management is not working, it’s likely time to consider surgical intervention. Microvascular Decompression (MVD) for trigeminal neuralgia is typically the first procedure recommended when medical management fails, and its benefits can far outweigh any concerns you may have about undergoing surgery.

Why MVD Is Indicated for Trigeminal Neuralgia

MVD for trigeminal neuralgia is recommended if your trigeminal nerve is impinged upon by structures like nearby blood vessels. Most often, the nearby blood vessel is causing the tremendous facial pain you experience on a daily basis, and unless that impingement is relieved, pain will continue. The trigeminal nerve is one of the primary conduits of sensation in your face and head. Compression on this nerve most often occurs near the root, as it moves away from the stem of your brain. And while medication can provide temporary relief to the pain caused by compression on this nerve, it often is not enough.

How MVD Is Performed

To perform MVD, your neurosurgeon must have access to the issue at its root. Your surgery will be performed on the side of your head where you are experiencing pain. First, an incision will be made through your scalp and the skin eased back to reveal the bone of your skull just behind your ear. Next, your surgeon will cut a small, circular hole (craniectomy) to gain access to the trigeminal nerve.

Once inside, your surgeon will compare your prior imaging results with what he is able to see firsthand. When the area of compression is identified, a Teflon surgical sponge is placed between the trigeminal nerve and whatever structure or vessel is impinging upon it. For most people, this is the superior cerebral artery.

What to Expect Before MVD

Surgical intervention for trigeminal neuralgia should only be considered after more conservative treatment has failed. As you explore the possibility of performing MVD for trigeminal neuralgia, your entire health history will be considered. Because MVD is intricate brain surgery that is performed under general anesthesia, your neurosurgeon must first determine if your overall health is sufficient to consider this procedure.

What to Expect During MVD

On the day of your surgery, the hair and scalp on the side of your head where you are experiencing pain will be washed with antiseptic soap. This is performed after you have undergone anesthesia. Next, your head will be placed in a fixed frame so that you can’t move it during the procedure. The neurosurgeon will then begin the operation. After the sponge is inserted, the surgeon will replace the region of skull that was removed with a bone substitute (cranioplasty) and fix it back into place. Finally, your skin is massaged back into place and sutured.  A small sterile dressing will cover the incision like a bandaid.

What to Expect After MVD

After your surgery is complete, you can expect to spend 1-3 days in the hospital. During this time, you’ll first be monitored in the recovery room, where the medical staff will watch to ensure your vital signs remain normal. Many patients are then moved to an Intensive Care Unit. As you become more alert, you may experience both nausea and post-surgical head pain. Both can be treated easily with intravenous or oral medications. Finally, as you improve, you’ll move to a regular room in the hospital and work with therapists to resume normal activities, including eating, sitting, standing and walking.

Once you’ve become proficient in those activities and are no longer dependent on medical staff, you’ll be discharged to your own home. Over the next few weeks, your strength will return and you will gradually reduce your pain medication. Ensure you have at-home help arranged, as you’ll need to avoid lifting anything heavy, standing for long periods of time and driving. Your doctor will let you know when it is safe to resume those activities after your follow-up medical visits.

Pros Versus Cons of MVD

MVD is a highly effective treatment for patients with trigeminal neuralgia caused by nerve impingement. Although most patients are able to come through the procedure with little or no side effects, you may still experience adverse events like prolonged bleeding, the development of blood clots or infection, anesthesia-related complications, swelling within your brain, or vascular reactions such as strokes and seizures.

Typically, extremely small numbers of patients face such complications. More commonly, you may experience spots of numbness or changes to your vision or hearing. In many cases, those experiences will not last long. Overall, it is very likely that you will regain those functions you lost to trigeminal neuralgia. Talking with your neurosurgeon is the best way to learn whether or not this procedure will be beneficial for you.
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