Trigeminal neuralgia (TGN) is considered to be one of the most painful conditions a person can have. If you’ve been diagnosed with trigeminal neuralgia, you are probably looking at all of your options to help alleviate the debilitating symptoms. While there are many treatment options now available for trigeminal neuralgia pain relief, microvascular decompression (MVD) is by far the most effective for the majority of patients that undergo this procedure.
What Is Microvascular Decompression?
Microvascular decompression is a procedure that not only addresses the root of TGN’s symptoms, but it also preserves full nerve function. This surgery is a great option for those whose TGN stems from nerve impingement caused by a blood vessel, such as an artery. The constant impact from the pulsing vessel can cause irritation of the trigeminal nerve, resulting in its subsequent malfunctioning.
Microvascular decompression is performed through a small “window” created at the base of the skull. Your neurosurgeon uses a specialized microscope and instruments to isolate the trigeminal nerve and the offending vessel. He or she will place a tiny Teflon sponge between the two structures, effectively creating a cushion for the nerve. Relief is usually noticed immediately, and because the nerve has not been damaged, full function is preserved.
An Overview of Microvascular Decompression
If diagnostic imaging shows that your TGN does stem from the above-mentioned vessel impingement, you may be a good candidate for MVD. If your doctor does determine your best choice would be MVD, it helps to be prepared prior to your procedure.
Getting Ready for Your MVD
There are a few preparations you can make that will help your surgery go as smoothly as possible. The first is making sure your insurance will cover your microvascular decompression. Your surgeon’s benefits liaison can help guide you through all of the steps of securing a pre-authorization, or, if necessary, pulling together the information needed to appeal a denial.
Once you have your pre-authorization, you can schedule your surgery. Be sure you have requested some time off from work, and arrange some help for the first few days after the surgery.
You may also have to have several tests, such as blood work, an electrocardiogram and additional imaging to ensure you are ready to undergo surgery. Many practices will have you sign the majority of your consent forms at this time, too, to make surgery day runs more smoothly.
The Procedure
MVD surgery is performed under general anesthesia. You will be prepped for surgery and given an anesthetic to make you fall asleep. There is no need for a large area of your head to be shaved; the surgical site is at the base of your skull and will require only about a one-inch square window of bone be removed for access. Overall, the entire procedure usually takes two to three hours.
Microvascular Decompression Recovery
Because MVD is does not require cutting through large amounts of tissue, recovery is fairly quick for most people. You can expect to spend a day or two in the hospital; once you are released to go home, you will need to take it easy for a few days. This includes not driving, lifting more than five pounds, doing housework or anything else that may put stress or strain of any sort on your body. Once you have your first follow-up visit, your doctor can advise you on which activities you can once again resume. The majority of people that undergo MVD surgery are able to get back to their normal routines within just a few weeks.
What Makes MVD So Effective?
Microvascular decompression is the most highly recommended surgery due to its efficacy and ability to (in most cases) provide full trigeminal neuralgia pain relief. This is through the placement of the tiny Teflon sponges, creating a very effective buffer between the vein or artery and nerve. The beauty is that it does not in any way damage the nerve or create other issues such as numbness, as may be experienced with other trigeminal neuralgia procedures. The other advantage is that the benefits of this procedure tend to last a lot longer than many other procedures – sometimes even producing permanent results.
What If MVD Isn’t For You?
If you aren’t a candidate for microvascular decompression, you still have other options. These include Gamma Knife Radiosurgery, pain stimulator placement and percutaneous rhizotomy. Each of these has their place in the spectrum of trigeminal neuralgia pain relief options.
Gamma Knife Radiosurgery
Gamma Knife Radiosurgery is helpful in cases where individuals cannot undergo anesthesia, or their trigeminal neuralgia is caused by a small tumor or lesion on the trigeminal nerve. As a completely non-invasive procedure, it allows for the patient to remain awake throughout the entire process. Around 200 tiny beams of radiation are finely focused on the target. Although they are not strong enough to create any damage to surrounding tissues as they pass through, when they all converge on the chosen area, they deliver a therapeutic dose of radiation. In the majority of cases, only one Gamma Knife Radiosurgery treatment is required.
Pain Stimulators
Pain stimulators are another option for those that aren’t suited for MVD. In this case, tiny electrodes are threaded underneath the skin and to the nerve. Short pulses of energy interrupt the malfunctioning impulses being created by the trigeminal nerve, allowing patients to achieve relief in most cases.
Percutaneous Rhizotomy
Lastly, percutaneous rhizotomy may be a good option for those who wouldn’t benefit from microvascular decompression. A minimally invasive procedure, it uses an electrode that is passed to the trigeminal nerve. It destroys the offending part of the trigeminal nerve, preventing the misfiring of impulses that can cause facial pain and discomfort.
If you’ve been recommended for microvascular decompression, learn as much as you possibly can about it. You may be surprised by just how effective it is in the battle against the debilitating pain and other symptoms associated with trigeminal neuralgia.
