Microvascular Decompression

Microvascular decompression (MVD) is a type of surgery that helps when a blood vessel presses on a nerve as it exits your brain. Healthcare providers call this neurovascular compression. It can cause sudden, sharp bursts of facial pain that feel like electric shocks. It may also lead to twitching or pulling of the muscles on one side of your face.

During the procedure, your surgeon moves the artery or vein away from your nerve. By shifting the vessel, the pressure on your nerve goes away. This eases symptoms while keeping your nerve safe.

What does microvascular decompression treat?

MVD may help with cranial nerve conditions. These affect the nerves that start in your skull, like:

• Trigeminal neuralgia
• Hemifacial spasm
• Geniculate neuralgia
• Glossopharyngeal neuralgia

How should I prepare for microvascular decompression?

You’ll meet with your surgeon before the procedure. They’ll order imaging tests. They’ll use an MRI and MRA because they give the clearest pictures of what’s happening.

You’ll also have a physical exam to be sure you’re healthy enough for surgery. Your care team will check the medications and supplements you take. They may ask you to stop taking some of them, as certain medications can cause side effects during surgery.

You’ll get specific instructions to follow before the day of the procedure. This may include only having clear liquids up until a few hours before surgery and arranging a ride to and from the hospital. If you have questions about the procedure or how to prepare, don’t be afraid to ask.

What happens during microvascular decompression?

On the day of surgery, you’ll get general anesthesia. This medicine puts you to sleep so you don’t feel pain. Your care team will clip a small area of hair behind your ear. Don’t worry — it’ll grow back after the site heals.

The steps may vary a little depending on where and what your surgeon needs to do. But in general, your surgeon and anesthesia team will:

1. Insert a breathing tube through your mouth into your windpipe.
2. Position you on your side.
3. Make a small cut (incision) in the skin behind your ear.
4. Remove a small piece of bone (about the size of a nickel) behind your ear.
5. Open the dura (the thin covering around your brain and spinal cord).
6. Use a microscope or an endoscope to find the compressed nerve.
7. Move the blood vessel away from the nerve.
8. Hold the blood vessel away using either a biologic glue, a sling, a titanium clip or a tiny Teflon™ sponge (soft pad).
9. Close the dura, skull opening and incision site.

When the anesthesia wears off, your care team will remove the breathing tube. They’ll watch you closely to make sure you’re recovering well.

How long does microvascular decompression take?

The procedure can take between two and three hours. Your surgeon will give you the best time estimate based on your situation.

Microvascular decompression benefits

This surgery may ease symptoms from certain cranial nerve conditions.

For example, it’s the “gold standard” treatment for trigeminal neuralgia because it treats the cause of the pain, not just the symptoms. Trigeminal neuralgia is a condition that causes severe facial pain that comes and goes. It’s often triggered by things like touching your face, brushing, eating or talking.

Studies show that about 8 to 9 out of every 10 people feel better soon after their procedure. The success rate five years later is 7 to 8 out of every 10 people from the same study.

After surgery, normal activities like chewing, talking and moving shouldn’t cause pain.

Microvascular decompression risks

MVD is a major surgery. Your surgeon makes an opening in your skull, you’ll be under general anesthesia and recovery can take time.

Before surgery, your care team will talk with you about the possible risks. These are rare, but may include:

• Blood vessel injury (stroke)
• Cerebrospinal fluid leak
• Facial numbness
• Hearing loss
• Infection

In some cases, the trigeminal neuralgia symptoms may return after surgery. One study found that pain came back for about 2 out of every 10 people within 10 years.

What happens after microvascular decompression?

After surgery, you’ll stay in the hospital for one or two nights. This lets your surgeon check that you are recovering well and watch for any problems. It’s normal to have a headache or pain near the incision.

Your care team will give you medicine to help you stay comfortable. A mix of long-acting numbing medicine placed in the incision during surgery, along with regular doses of Tylenol®, an anti-inflammatory (NSAID), magnesium and a muscle relaxer can help control pain and reduce the need for opioid medications.

Before you go home, your providers will make sure you’re healthy enough to leave. They’ll check for complications and give you clear instructions to care for yourself. You’ll also get guidance on how to manage pain at home.

Once you’re home, you’ll need to avoid heavy lifting or strenuous activity, but walking is encouraged. If you have questions or concerns, contact your care team right away.

How long does it take to recover from microvascular decompression surgery?

Many people feel pain relief right after surgery. Even if symptoms are gone, recovery takes time because your surgeon made an opening in your skull. You’ll likely feel sore for one to two weeks.

Your surgeon will tell you when it’s safe to return to harder physical activities. Four to six weeks is typical to avoid those.

You should be able to get back to your normal routine in about a month. This timeline can vary, so talk to your surgeon.

If you take certain medicines, like anti-seizure drugs for facial pain, your neurosurgeon will let your neurologist know when it’s safe to start slowly reducing them after surgery. These medicines should only be decreased under your neurologist’s direction. Don’t stop them suddenly, as that can cause withdrawal symptoms.

When should I call my healthcare provider?

Let your provider know right away if you have any of the following symptoms after surgery:

• Balancing problems
• Dizziness
• Fever over 100.4 degrees Fahrenheit (38 degrees Celsius)
• Incision site issues (severe pain, swelling, pus, bleeding)
• Leakage of fluid from your incision, ear or nose
• Loss of hearing or ringing in your ears
• Severe headache
• Sudden weakness, numbness or facial drooping