Microvascular Decompression

What is a Microvascular Decompression?

The clinical term “Microvascular Decompression (MVD)” refers to a surgery that relieves the symptoms (pain, muscle twitching) of abnormal compression of a cranial nerve. Microvascular decompression process usually involves opening of the skull, known as craniotomy, and insertion of a tiny sponge between the compressing vessel and the nerve. The sponge helps to isolate the nerve from the pressure of the blood vessel.

This neurosurgical procedure mostly used to treat trigeminal neuralgia, glossopharyngeal neuralgia, or hemifacial spasm. Clinicians also used this technique experimentally to treat vertigo and tinnitus caused by vascular compression on the vestibulocochlear nerve. Trigeminal neuralgia results in due to the irritation of the 5th cranial nerve causing severe pain that usually affects one side of the face, normally in the forehead, cheek, jaw, or teeth ¹.

Surgeons place a sponge in between the trigeminal nerve and the superior cerebellar artery or a branch of the petrosal vein as a treatment of trigeminal neuralgia. Whenever the compression removes, the painful symptoms diminished subsequently. Sometimes medication provides initial relief, but that’s not the permanent solution.

Research estimates the annual incidence rate of trigeminal neuralgia near about 5.7 per 100,000 women and 2.5 per 100,000 men, approximately ². The prevalence of incidence increases with age and peak incidence lies in people between 50 to 60 years of age ³.

What types of conditions does a Neurosurgeon Employ a Microvascular Decompression?

As we said earlier, microvascular decompression used to treat the patient with trigeminal neuralgia, glossopharyngeal neuralgia, or hemifacial spasm. Initially, drugs like antiepileptic/antineuralgic can provide excellent pain relief. However, 10% of patients will not respond to these drugs and will still qualify as candidates for MVD.

You will be a perfect candidate for MVD if develops ⁴:

1. Trigeminal neuralgia, that seems uncontrollable with medication
2. Facial pain observed in the ophthalmic division or in all three trigeminal divisions
3. Recurrent facial pain after a previous radiosurgery procedure

Your surgeon won’t recommend you for the MDV surgery if you have some other medical conditions and poor body condition to overcome the general anesthesia. MDV may not be suitable for treating facial pain caused by multiple sclerosis and patients with hearing loss problem.

How do Neurosurgeons Perform a Microvascular Decompression?

The Microvascular Decompression surgery requires an experienced neurosurgeon, a neurologist, an anesthesiologist, and an assistant to perform successfully. This operation generally takes 2 to 3 hours to perform. The entire process includes ⁵:

1. You need to lie on the operation table and surgeons will perform general anesthesia to make you sleep so that you will not feel any pain or sensation.
2. Surgeons will make a 3-inch curved skin incision behind your ear.
3. Your surgeon will split the skin and head muscles to expose the occipital bone in the skull.
4. Then he will make a 1-inch opening in the occipital bone with a drill and remove the skull to get excess to the brain.
5. Surgeon will place a retractor on the brain to open a corridor to expose the trigeminal nerve and identify any offending vessel causing compression.
6. Then he will cut a Teflon sponge in an appropriate size and inserts it between the nerve and the vessel.
7. Sometimes, surgeons will cauterize a vein that adheres to the nerve and causing compression.
8. After the successful placement of a sponge, surgeons will use a titanium plate to cover the skull opening and make it secured with tiny screws.
9. Finally, surgeons will suture the muscle and skin back together and place a soft adhesive dressing over the incision.

After this operation, you’ll stay in the hospital for a couple of days. Nurses will monitor your overall condition during these days to make sure no complications arise. A regular course of antibiotics will prevent any post-surgical infections in the surgical site. Talk to your surgeon in case of any post-surgical abnormalities.

References

1. Yang, D. B., Wang, Z. M., Jiang, D. Y. & Chen, H. C. The efficacy and safety of microvascular decompression for idiopathic trigeminal neuralgia in patients older than 65 years. J. Craniofac. Surg. 25, 1393–1396 (2014).
2. Dahle, L., von Essen, C., Kourtopoulos, H., Ridderheim, P. Å. & Vavruch, L. Microvascular decompression for trigeminal neuralgia. Acta Neurochir. (Wien). 99, 109–112 (1989).
3. Wang, X. et al. The long-term clinical outcomes of microvascular decompression for treatment of trigeminal neuralgia compressed by the vertebra-basilar artery: A case series review. BMC Neurol. 19, 1–6 (2019).
4. Li, Y., Yang, L., Ni, J. & Dou, Z. Microvascular Decompression and Radiofrequency for the treatment of Trigeminal Neuralgia: A Metaanalysis. J. Pain Res. 12, 1937–1945 (2019).
5. Wang, D. D. et al. Prospective comparison of long-term pain relief rates after frst-time microvascular decompression and stereotactic radiosurgery for trigeminal neuralgia. J. Neurosurg. 128, 68–77 (2018).