What is microvascular decompression?
MVD is a surgical procedure to relive the symptoms (pain, muscle twitching) caused by compression of a nerve by an artery or vein. Surgery involves opening the skull (craniotomy) and exposing the nerve at the base of the brainstem to insert a tiny sponge between the compressing vessel and the nerve. This sponge isolates the nerve from the pulsating effect and pressure of the blood vessel.
Trigeminal neuralgia is an irritation of the fifth cranial nerve causing severe pain that usually affects one side of the face, normally in the forehead, cheek, jaw, or teeth. To treat trigeminal neuralgia, a sponge is placed between the trigeminal nerve and the superior cerebellar artery or a branch of the petrosal vein. By removing the compression, the painful symptoms are relieved.
Who needs MVD?
You may be a candidate for MVD if you have:
- Trigeminal neuralgia that is not well controlled with medication and you desire minimal to no facial numbness that may be associated with other treatments such as percutaneous stereotactic radiofrequency rhizotomy (PSR) or glycerol injection
- Facial pain isolated in the ophthalmic division or in all three trigeminal divisions
- Facial pain recurrence after a previous percutaneous or radiosurgery procedure
Because MVD involves the use of general anesthesia and brain surgery, patients with other medical conditions or who are in poor health may not be candidates. MVD is not successful in treating facial pain caused by multiple sclerosis. Because of the low risk of hearing loss, MVD may not be suitable for patients who have hearing loss in the other ear.
How should I prepare for MVD?
You will typically undergo tests (e.g., blood test, electrocardiogram, chest X-ray) several days before surgery. In the doctors office you will sign consent forms and complete paperwork to inform the surgeon about your medical history (i.e., allergies, medicines, anesthesia reactions, previous surgeries). Discontinue all non-steroidal anti-inflammatory medicines (Naproxin, Advil, etc.) and blood thinners (coumadin, aspirin, etc.) 1 week before surgery. Additionally stop smoking and chewing tobacco for 1 week before and 2 weeks after surgery because these activities can cause bleeding problems. Wash your hair with Hibiclens® (chlorhexidine) antiseptic soap for 3 consecutive days prior to surgery. No food or drink is permitted past midnight the night before surgery.
What should I expect during MVD?
The operation generally takes 2 to 3 hours.
You may experience some nausea and headache after surgery; medication can control these symptoms. When your condition stabilizes, you’ll be transferred to a regular room where you’ll increase your activity level (sitting in a chair, walking). In 1 to 2 days, you’ll be released from the hospital and given discharge instructions
What are the risks of MVD?
As with all surgeries, there will always be risks. General complications can include bleeding, infection, blood clots, and reactions to anesthesia. Specific complication related to a craniotomy may include stroke, seizures, venous sinus occlusion, swelling of the brain, and CSF leak. The most common complication related to MVD is nerve damage, which varies depending on the nerve being treated; these include hearing loss, double vision, facial numbness or paralysis, hoarseness, difficulty swallowing, and unsteady gait.
Contact your provider immediately if you experience any of the following:
- A temperature that exceeds 101°F
- An incision that shows signs of infection, such as redness, swelling, pain, or drainage.
- If you are taking an anticonvulsant, and notice drowsiness, balance problems, or rashes.
- Decreased alertness, increased drowsiness, weakness of arms or legs, increased headaches, vomiting, or severe neck pain that prevents lowering your chin toward the chest.