Microvascular Decompression of Trigeminal Nerve
What is Microvascular Decompression of the Trigeminal Nerve?
The trigeminal nerve is the 5th cranial nerve which branches to provide sensation to different parts of the face including the eyes, cheek, and jaw. Trigeminal neuralgia causes pain in these regions of the face when the trigeminal nerve is compressed by a blood vessel. On rare occasions, the trigeminal nerve may be compressed due to a tumour in the brain. Patients with trigeminal neuralgia experience episodes of severe facial pain, which can be triggered by talking, chewing, or touching the face.
When is Microvascular Decompression of the Facial Nerve Indicated?
Microvascular decompression surgery is indicated when conservative therapy fails to relieve symptoms of trigeminal neuralgia.
It is also indicated when pain recurs after a percutaneous or radiosurgery procedure.
Microvascular decompression surgery is however contraindicated in patients in poor health.
It is also not suggested to treat facial pain associated with multiple sclerosis.
How Should I Prepare for Microvascular Decompression of the Trigeminal Nerve?
- Discuss the procedure, risks, benefits, and expected outcomes with your surgical team.
- Sign consent form.
- Attend all preoperative appointments and imaging studies.
- Inform your doctor about medications, allergies, and medical conditions.
- Stop certain medications, such as blood thinners, supplements, and fish oil.
- Follow fasting instructions carefully.
- Arrange transportation and support for recovery.
What Happens During Microvascular Decompression of the Trigeminal Nerve?
During microvascular decompression of the Trigeminal nerve, the patient is placed under general anaesthesia. The surgeon makes a small incision behind the ear and creates a small opening in the skull to access the Trigeminal nerve near the brainstem. Using a microscope, the surgeon identifies the blood vessel compressing the nerve and carefully moves it away. A tiny cushion, usually made of Teflon, is placed between the vessel and the nerve to prevent further contact. The incision is then closed and covered with a soft adhesive dressing.
What Happens After Microvascular Decompression of the Trigeminal Nerve?
After microvascular decompression of the Trigeminal nerve, patients are closely monitored in the recovery area and may spend a short time in the intensive care unit. Most remain in the hospital for two to five days. Neuralgia often improves immediately, though some patients experience gradual improvement over several weeks or months. Temporary headaches, dizziness, nausea, balance issues, or incision discomfort may occur. Follow-up appointments are scheduled to assess healing, symptom relief, and recovery progress.
What are the Risks and Benefits of Microvascular Decompression of the Trigeminal Nerve?
Risks and benefits of microvascular decompression of the facial nerve include the following:
Benefits:
- Addresses the underlying cause of Trigeminal nerve compression.
- Provides long-term or permanent relief from neuralgia in many patients.
- Can significantly improve quality of life and daily functioning.
Risks:
- Post operative haematoma
- Infection (wound, CSF, urine, chest)
- Adverse reactions to anaesthesia.
- Hearing loss
- Facial numbness
- Cerebrospinal fluid (CSF) leak.
- Stroke, nerve injury, or recurrence of symptoms, although these complications are uncommon
- Complications related to other medical conditions (heart, lungs, kidney)
- Clots in legs (Deep venous thrombosis) and clots in lungs (pulmonary embolus)
- Non resolution of neuralgia
Note: Your surgeon will advise you on how likely the above complications are.
What can I expect when I am discharged from hospital
- You may experience pain (including headache), inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- Keep the surgical site clean. Instructions on surgical site care and bathing will be provided.
- Refrain from smoking and alcohol until your first follow up visit as it can negatively affect the healing process.
- Refrain from lifting anything heavier than 5 Kg and other strenuous activities until the first follow-up visit. These activities may include housework, yard work, gardening, mowing, etc.
- Gentle exercise and regular walking are recommended to improve strength and endurance from 2 weeks after surgery.
- Refrain from driving until you are fully fit and receive your surgeon’s clearance.
- Most patients can return to their normal daily routines in 4-6 weeks after surgery.
