MICROVASCULAR DECOMPRESSION 
(MVD)
Surgical Treatments for Facial Neuralgias

Disclaimer.

Many cases of classical-type Trigeminal Neuralgia and Glossopharygeal Neuralgia are caused by a blood vessel that presses on the trigeminal nerve near its root. In a microvascular decompression (MVD) operation, the nerve and blood vessel are separated and a Teflon plate is placed between them to stop the pressure.

A very recent study [1] indicates long-term effectiveness for approximately 70% of trigeminal neuralgia patients undergoing MVD. If performed well, the procedure is unlikely to cause nerve scarring, meaning that MVD causes very little numbness. The pain is also not likely to return.

However, MVD is not a miracle cure. Not all patients with TN-like symptoms have compression of the nerve as the leading cause of the pain.   In particular, this surgical procedure has mixed results on Atypical Trigeminal Neuralgia. It also may not be appropriate for Atypical Facial Pain.

Also, on the downside, MVD is a major brain operation that is performed under sedation. There are always risks involved with such operations, especially for elderly patients. MVD is also an expensive operation. All these factors must be weighed when MVD is considered as a treatment.

References

[1]. Fred G. Barker II, Peter J. Jannetta, David J. Bissonette, Mark V. Larkins, Hae Dong Jho . The Long-Term Outcome of Microvascular Decompression for Trigeminal Neuralgia. New England Journal of Medicine 1996;334:1077-83.

Links

The following sites have information on MVD.

HMS: Microvascular Compression Syndromes.

  Microvascular decompression of cranial nerves: lessons learned after 4400 operations
Journal of Neurosurgery article by Mark R. McLaughlin, M.D., Peter J. Jannetta, M.D., Brent L. Clyde, M.D., Brian R. Subach, M.D., Christopher H. Comey, M.D., and Daniel K. Resnick, M.D.- September 8, 1998. 
Reviews some of the technical aspects of  MVD  based on over 4,400 procedures and discusses operative techniques in detail with numerous illustrations. Included are methods to avoid complications.

Positive experiences

"Now I wonder why I did not do it much sooner, and why I or anyone would suffer through all that pain for so long when it was not necessary." "Sally"

"I had ten hours of brain surgery. I woke up without any pain in my face , or around my eye. I was told that I had three blood vessels compressing the nerves, and two of those were badly damaged." "Dianne".

Negative Experiences

"Nonetheless when I awoke from my MVD performed in 1979, I found the left side of my face was completely paralyzed. This was a risk of which I had not been informed. Most patients are given complete risk disclosure and come through the surgery well, even if they do not obtain relief, but I believe it is imperative that they also do research on their own and are made aware of the fact that MVD carries some very unpleasant risks" - Anonymous