This video shows the view down our microscope of a trigeminal nerve being hit by a curving red artery (from the left). Eventually, I pushed the artery away from the nerve (to the left) and put some Teflon on it to keep it in place. The patient was cured of trigeminal neuralgia and had no complications.
This video is a .mp4 file and should run on most PCs and MACs. It is very large, 5.2 MB, and may take a while to download.
Download a pamphlet on Microvascular Decompression
Introduction
Patients should speak directly with their neurosurgeon to fully understand the benefits and risks of this surgery.
The MVD operation is designed to cure the problem. It is very similar to that described on the MVD for Hemifacial Spasm page only in this case, it is the Vth cranial nerve (the trigeminal nerve) that is decompressed. This operation is done under a general anesthetic and takes approximately three hours. Patients typically go home after several days in hospital. The scalp behind the ear (on the side of the pain) is shaved and an incision made through the skin and muscles. A small hole is drilled through the skull. The surgeon operates around the outside of the brain until the trigeminal nerve is seen through the microscope (see video above). The offending artery or vein is identified and moved away from the nerve. A small patch of padding is placed between the nerve and artery to prevent future compression. The hole in the skull is replaced with acrylic and the muscles and scalp sutured closed.
Benefits
The cause of the trigeminal neuralgia is fixed and the patient is left with normal sensation and movement in their face. The surgery decompresses the nerve from the pounding by the blood vessel. This typically stops the pain (90%) but occasionally the nerve is too damaged from the long-term compression that it does not heal (10%) and patients continues to have pain. Over time, there can be a recurrence of pain. At one year after surgery, 90% of patients are pain free and by ten years post-op approximately 80% remain pain free.
Risks
Patients are urged to speak directly with their surgeons about complication rates, which can vary among institutions. This is a complex operation and has potentially serious risks. With the general anesthetic and operating close to the brain stem there is the rare chance of death or disabling stroke. We have not had a death but is has been reported in the literature. Injury to the surrounding nerves could cause permanent deafness, facial droop, double vision, facial numbness, or difficulty swallowing. There is a risk of infection or delayed CSF leak (salt water-like fluid escaping from around the brain and draining through the middle ear into the back of the throat). Patients can expect temporarily discomfort at the incision but this is rarely permanent. Patients can develop a chemical meningitis which causes a new severe headache several days after the surgery. There is a small chance that the pain will not be fixed or will recur.
Post-operative Instructions
Patients typically leave hospital after two nights. There will be a small wound behind their ear covered with a bandage and a tensor bandages wrapped around the head. Keep the wound dry (no swimming or shower but bath is OK if bandage stays dry) until the family doctor removes the stitches. Stitches should be removed after 10 days and the tensor bandage can be thrown away at that time as well. There should be no strenuous activity for 6 weeks. “Strenuous activity’ means anything where you might grit your teeth in order to lift something. Lifting a bag that does not change the way you breath is OK. Walking is fine. Avoid any activities where you might fall and hit your head (e.g. bicycling, roller-blading, skiing etc.) We expect that you will have some headache or wound discomfort for a few weeks. This discomfort responds to Tylenol.
If there are any problems with the wound (your family doctor thinks it might be infected) please call us. If you develop a severe headache a few days after discharge from the hospital, please call us.
We expect to see you in our office 6 weeks after surgery for a follow-up examination.
If you continue to have hemifacial spasm after surgery do not panic. The operation was designed to decompress the nerve to not heal it. Your body will take time to heal the facial nerve (i.e. remyelinate it). This can take up to a year. Many patient, however, are spasm free immediately after surgery.
