Trigeminal Neuralgia: Microvascular Decompression
Surgical decompression of the trigeminal nerve to treat trigeminal neuralgia, is termed microvascular decompression (MVD). The goal of MVD is to "decompress" the pressure on the nerve and reduce nerve sensitivity. This allows the trigeminal nerve to recover from its state of hyperactivity and return to a normal, pain free condition.
Procedure
Microvascular decompression (MVD) surgery is performed under general anesthesia, through a sterile incision and small (3x3cm) bony opening behind the ear (craniotomy) with an applied head fixation device in place. The surgeon uses an operative microscope, to view the cerebellum and visualize the trigeminal nerve.
The operation itself involves microsurgical exposure of the trigeminal nerve root, identification of the responsible artery, and then gently displacing it away from the point of compression. Decompression is maintained by an implant, such as Teflon® felt, positioned between the responsible artery and the trigeminal nerve.
 exposure of the trigeminal nerve root |  identification of the responsible artery |
 displacement from the point of compression |  decompression maintained by Teflon® felt |
 microelectrode recording |  microelectrode lateral x-ray |
To make sure that other nerves are not damaged by the surgery, the surgeon carefully monitors facial and acoustic nerve function using needle electrodes inserted into muscles around the eye and mouth.
Post-procedure
Following the "decompression" procedure and closure of the bony opening behind the ear, you will be awakened and allowed to recover from anesthesia. Most patients remain in the hospital for observation overnight, and can gradually return to full activity within a few weeks.
Pain relief is usually immediate, and medications are gradually discontinued over two weeks following surgery.
Risk of Microvascular Decompression
This procedure is safe. Complications are unlikely but possible. Operative complications can include operative death, obstruction of brain stem local blood supply, cerebellar hematoma, cerebellar swelling, hydrocephalus, partial facial paralysis, hearing loss, extra-ocular partial muscle paralysis, cerebrospinal fluid leak, bacterial meningitis, and severe postoperative headache.
