Vascular compression of the trigeminal nerve in the
cerebellopontine angle is now generally accepted as
the primary source or “trigger” causing Trigeminal
Neuralgia (TN). Microvascular Decompression (MVD)
is a neurosurgical procedure used to treat TN. The compression
is usually either caused by the superior cerebellar
artery or the anterior inferior cerebellar artery.
The 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).
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 mobilise 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: an artery compresses
the trigeminal nerve.
During MVD, the vessel is mobilised
away from the nerve root
The decompression is maintained
with Teflon implants.
MVD results in permanent alleviation
of the neurovascular compression.
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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