Part Two: Treatment of Trigeminal Neuralgia

III.  Surgery



B.
Microvascular Decompression Surgery

     Microvascular decompression (MVD) surgery is performed under general anesthesia, through an incision and small thumbprint sized bony opening behind the ear (craniotomy). The surgeon peers into the opening through an operative microscope, looks around the cerebellum (a structure of the brain) and visualizes the trigeminal nerve as it arises from the brain stem (the trigeminal nerve root entry zone).

Where the hole is made behind the ear.
 
The hole made behind the ear.

    The aim of MVD surgery is to alleviate neurovascular compression upon the trigeminal nerve root. This permits the trigeminal nerve nucleus to recover from its state of hyperactivity and return to a normal, pain free condition. Micro-instruments are used to mobilize the offending vessels away from the trigeminal nerve root. The decompression is permanently maintained by inert implants, such as those made of shredded Teflon® felt, between the offending vessels and nerve.

Prior to MVD   During MVD, the vessel is move away from the trigeminal nerve root entry zone.
Prior to MVD.
 
During MVD, the vessel is mobilized away from the nerve root entry zone.
Shredded Teflon® Felt Implants are inserted between the nerve and vessel.   When complete, MVD has resulted in permanent decompression.
The decompression is maintained with shredded Teflon® felt implants.
 
MVD has resulted in permanent alleviation of the neurovascular compression.

     

Teflon® felt implants
 
Operative microscopes used during the procedure
Inert shredded Teflon® felt implants.
 
Operating microscopes

    Following the microvascular decompression, the bone and incision are closed. The patient is awoken from the anesthetic and is taken to the recovery room. Most patients then remain in hospital for a couple of days, and gradually return to full activities within a few weeks. TN pain relief is usually immediate, and medications are gradually discontinued over two weeks following surgery. If pain does recur, it may be more easily treated with medications than before, or retreated with any of the neurosurgical procedure options.

    MVD is a non-destructive technique, and has the best potential for long-term relief or cure of TN pain. However, there is a small risk of complications related to cranial nerve damage including hearing loss and facial numbness. Intra-Operative Monitoring has improved the safety of this procedure. Other risks include the rare incidence of post-operative infection, inflammation or healing difficulty leading to CSF leak. The risk of developing some facial numbness is very small, and the development of deafferentation pain or anesthesia dolorosa is almost unheard of. Other serious complications related to stroke, bleeding, or swelling are exceptionally rare at centres with special expertise in performing MVD surgery.

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Trigeminal Neuralgia
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A. M. Kaufmann & M. Patel
Centre for Cranial Nerve Disorders

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© 2001


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