Microvascular Decompression (MVD) is a surgical procedure that relieves abnormal compression of a cranial nerve. It is performed to treat trigeminal neuralgia, vagoglossopharyngeal neuralgia, and hemifacial spasm. These conditions are often caused by an artery or vein compressing the nerve root as it leaves the brainstem. When compressed, normal nerve impulses can recruit nearby nerve fibers and send faulty messages. Medications often provide relief to patients with these conditions, but when medications become ineffective or cause serious side effects, one treatment option is MVD.
What is MVD?
MVD is a surgical procedure to relieve the symptoms (pain, muscle twitching) caused by compression of a nerve by an artery or vein. MVD involves surgically opening the skull (craniotomy) and exposing the nerve at the base of the brainstem to insert a tiny sponge between the compressing vessel and the nerve. This sponge isolates the nerve from the pulsating effect and pressure of the blood vessel.
Trigeminal neuralgia is an irritation of the fifth cranial nerve causing severe pain that usually affects one side of the face, normally in the forehead, cheek, jaw, or teeth (Fig. 1). To treat trigeminal neuralgia, a sponge is placed between the trigeminal nerve and the superior cerebellar artery or a branch of the petrosal vein. By removing the compression, the painful symptoms are relieved.
Who is a candidate for MVD?
You may be a candidate for MVD if you have:
* trigeminal neuralgia that is not well controlled with medication and you desire minimal to no facial numbness that may be associated with other treatments such as percutaneous stereotactic radiofrequency rhizotomy (PSR) or glycerol injection
* facial pain isolated in the ophthalmic division or in all three trigeminal divisions
* facial pain recurrence after a previous percutaneous or radiosurgery procedure
Because MVD involves the use of general anesthesia and brain surgery, patients with other medical conditions or who are in poor health may not be candidates. MVD is not successful in treating facial pain caused by multiple sclerosis. Because of the low risk of hearing loss, MVD may not be suitable for patients who have hearing loss in the other ear.
MVD Surgical Risks:
- Surgical Wound Infection with Lasting Pain, including menengitis.
- Cerebral Spinal Fluid Leaks
- Anesthesia Dolorosa -- burning pain underlying facial tactile numbness
- Parasthesia -- an itchy, crawly sensation combined with surface numbness
- Facial Numbness -- loss of sensation without other sensory effects
- Partial Facial Paralysis
· Loss of Hearing (rare, and only with MVD)
· Loss of the Tearing Reflex of the Eye, with a Risk of Ulceration to the Cornea (also MVD)
· Surgical Adhesions and Arachnoiditis
· Central Nervous System Fluid Leak (rare, and only with MVD)
· Differentiation Pain (caused by surgical interruption of connections between peripheral nerve endings and the central nervous system).
Imagery of MVD:
The following YouTube link provides an unusually clear and well explained description of what is done in a complex MVD for Geniculate Neuralgia and face pain. Though graphic in detail, it offers one of the better descriptions for what actually occurs in MVD, and how small a place this area near the brain stem actually is, to work. [R.A.L.]
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