Living with trigeminal neuralgia means more than just enduring constant pain. It means internally flinching every time you bite into something cold, wondering if it’ll trigger an episode. It means bracing against a cool wind, hoping its touch doesn’t set off more pain. It means clenching your face every time a new streak of fire races between your jaw and the top of your head. When medication fails to relieve or mask your pain, or injections prove not to be the answer, it may be time to pursue microvascular decompression for trigeminal neuralgia.
Preparing for any type of surgery can seem daunting, and knowing this surgery will include a small incision may mean that you have a lot of questions to ask before you feel comfortable undergoing this procedure. Use this guide to learn more about what to expect from microvascular decompression for trigeminal neuralgia.
Microvascular Decompression Is Minimally Invasive Brain Surgery
Medical procedures involving your head and brain are serious propositions for serious ailments. Having said that, the area where your surgeon will access to perform this intervention is far smaller than what is required for other types of brain surgery. The incision is placed in the rear of your head, behind your ear, so your hair may be able to hide that site in the future. The area of bone cut out to reveal the trigeminal nerve and the blood vessel compressing it will likely be about an inch in diameter — which is only about the size of a quarter.
Any brain surgery is, by definition, invasive. However, because microvascular decompression targets just the trigeminal nerve in a very specific location and requires only a relatively small cut-out to access, it is much less invasive than other brain procedures. Nevertheless, electing to have brain surgery is always a very serious decision to undertake.
Microvascular Decompression Is Performed Under General Anesthesia
Because microvascular decompression for trigeminal neuralgia is performed under general anesthesia, your doctor and the surgical anesthesiologist or nurse anesthetist will want you to disclose your full medical history in order to ensure that you are healthy enough to undergo general anesthesia. Be sure to discuss any reactions you’ve ever had to any medication with your surgical team, no matter how minor they may have been. A variety of medications are used inpatient sedation and it’s important to avoid any that may cause a reaction in you. Also important to discuss is any history or risk of heart attack, stroke or lung complications.
Other areas to discuss with your doctor include any history of bleeding or clotting issues, whether you may be pregnant and all medications that you routinely or periodically take.
Microvascular Decompression Is an Inpatient Procedure
Unlike some other forms of surgical treatment for trigeminal neuralgia, microvascular decompression is performed as an inpatient procedure. After you are brought out of sedation, you’ll be monitored closely in a surgical unit or intensive care unit. You may be in the hospital for several days, or until you are able to eat without needing IV nutrition, can manage surgical site pain, show no sign of infection and are alert and show no signs of abnormal neurological outcomes.
To prepare for your hospital stay, arrange for someone else to drive you there and back. Also, remember to consult with your doctor about whether you should continue or discontinue any medications you are on. You may be given a special shampoo to prepare your head and hair, and you will likely be advised to fast directly prior to your procedure. Leave all jewelry or valuables at home or with the person who has accompanied you to the hospital, and pack any comfort items you may want with you in your hospital room, including underwear and sleepwear.
The Process of Microvascular Decompression
Microvascular decompression for trigeminal neuralgia is a very methodical procedure:
- You will be sedated by the anesthesiologist.
- A skin incision will be made behind your ear and a small-circumference circle will be made to reveal the area of the trigeminal nerve. Hair may be cut or shaved to allow access.
- Your doctor will identify the trigeminal nerve and whichever blood vessel is impinging it, then place a Teflon sponge between the two to decompress the nerve.
- Either the piece of bone will be replaced or a surgical steel or titanium circle used in its place before the skin incision is closed.
- You will be brought out of sedation.
What Happens After Microvascular Decompression
After you are monitored for several days as an inpatient, you’ll be released to go home. Your normal activities may be restricted for a period of time as your surgical site heals and you regain your strength. You may be released with a prescription for pain medications to take for either a few days or a few weeks, depending on your level of pain and pain tolerance. Your ability to bathe around the surgical site may be restricted for several days to avoid the risk of infection.
After microvascular decompression for trigeminal neuralgia, you will likely experience headaches related to the surgery itself. That pain will lessen over time. Microvascular decompression is considered highly effective in the treatment of trigeminal neuralgia, but results can differ between patients.
