If you suffer from the severe, disabling facial pain of trigeminal neuralgia, you’ll likely consider several treatment options when medications fail to provide relief. One of the most common interventions doctors recommend is trigeminal nerve decompression surgery, otherwise known as microvascular decompression (MVD). This minimally invasive procedure carries few postoperative risks and often involves long-lasting relief. Here are some questions to ask your doctor before undergoing the remediation.
Why Are You Recommending Decompression Over Other Treatments?
Decompression is one of several procedures for trigeminal neuralgia that include Gamma Knife Radiosurgery, percutaneous rhizotomy and pain stimulator placement. Since statistics show pain relief lasts longer after decompression surgery, doctors will typically choose it for individuals deemed to be at low risk of the adverse effects of general anesthesia. Good candidates for this intervention are people who don’t have major health issues and are younger than 70 years of age. However, people older than 70 who are in good physical condition also tolerate it well. The other treatments are advised for elderly or debilitated patients.
What Is Trigeminal Nerve Decompression Surgery?
In this procedure, the medical team gets to the root of the problem by moving or padding blood vessels compressed by the trigeminal nerve. The first step involves making an incision behind your ear and creating a small opening in your skull. A microscope will be used to identify the spot where an artery or vein is lying over your nerve. Next, your artery will be separated from your nerve by inserting a small Teflon pad (or pads) to act as a cushion. The last step consists of covering the opening in the skull with a cranioplasty and then suturing the skin and muscles back together.
What Will Happen Before and After the Surgery?
Preparations for trigeminal nerve decompression surgery start one week prior to the event, when you’ll discontinue taking non-steroidal, anti-inflammatory and blood thinning medications. Several days prior to the operation, you’ll undergo an electrocardiogram, blood tests and a chest x-ray as well as complete questionnaires about your medical history. On the night before the surgery, you are to abstain from ingesting food and water after midnight.
It’s standard protocol for decompression patients to enter the hospital the morning of the intervention. At this time, a nurse will explain the process and answer any questions. You’ll also meet with a doctor who will explain the effects and risks of the medications used in anesthesia. In the final preparatory step, the team will start an intravenous line in your arm before they take you into the operating room.
Following the surgery, your vital signs will be monitored in the recovery room until you rouse from the anesthetic state. Afterward, you’ll be taken to an intensive care unit for an overnight stay. If you have a headache or feel nauseated, these symptoms can be managed with medications. Once you become stable, you’ll be transferred to a regular room, where you can gradually increase your activity level. Release from the hospital will likely transpire in one or two more days.
Discharge instructions will pertain to discomfort alleviation, activity restrictions and bathing. Your doctor will give you a prescription for an oral pain reliever to take for a limited time. You’ll also be advised to refrain from driving, lifting objects heavier than five pounds and engaging in housework for a designated period. It’s permissible for most people to resume showering and shampooing three days following their hospital release.
What Are the Risks of Trigeminal Nerve Decompression Surgery?
Every surgical procedure carries the risks of blood clots, infection, bleeding and adverse effects of anesthesia. Hazards associated with the surgical creation of an opening in the skull include seizures, stroke and swelling of the brain. Although rare in experienced hands, potential negative effects of the decompression procedure include nerve stretch or damage that can result in hearing loss and other disorders.
After surgery, get medical attention if you experience certain symptoms. These include reduced alertness, a fever above 101 degrees Fahrenheit, vomiting, severe neck pain, worsening of headaches and weakness in extremities. In addition, call your doctor if the incision shows signs of infection such as redness, pain, swelling or discharge.
What Is the Success Rate?
Every patient is different and, as such, should be educated as an individual. On average, good MVD candidates can expect complete relief of pain approximately 80-90 percent of the time. More often than not, patients will find themselves on little or no medication compared to before MVD surgery. It is possible for the pain to recur, however, and in these situations, re-operation, gamma knife radiosurgery, percutaneous rhizotomy and pain stimulation can be considered.
Although trigeminal neuralgia may have caused you misery and excruciating pain for a long time, you needn’t feel that you must endure this agony for the rest of your life. Many patients get substantial relief through the highly successful intervention of trigeminal nerve decompression surgery. Discuss it with your doctor to see if the treatment is right for you.
