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About The Surgery

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Microvascular Decompression MVD

MVD is a surgery to calm the symptoms (pain, muscle twitching) caused by compression of a nerve by an artery or vein. The medical procedure includes opening the skull (craniotomy) and uncovering the nerve at the base of the brainstem to embed a tiny sponge between the compressing vessel and the nerve. This sponge separates the nerve from the pulsating effect and pressure of the blood vessel.

What is Microvascular Compression Syndrome?

In microvascular compression syndrome (MCS), vertigo, tinnitus and motion intolerance are credited to the inflammation of the eighth cranial nerve by a blood vessel.

The presence of MCS is induced by a disorder of hemifacial spasm, in which the usual cause is a similar aberrant blood vessel influencing the seventh cranial nerve.

What is the Objective of MVD?

The motivation behind microvascular decompression is to ease pressure from vessels that are squeezing against the trigeminal nerve, and cause painful impulses in the face. To treat trigeminal neuralgia, a small sponge is placed between the trigeminal nerve and the blood vessels pushing on it.

Who is a Candidate for This Procedure?

You might be a contender for MVD if you have:

  • Trigeminal neuralgia that isn't well controlled with medication.
  • Facial pain separated in the ophthalmic division or in every one of the three trigeminal divisions
  • Facial pain recurrence after a previous percutaneous or radiosurgery procedure

Since MVD includes the use of general anaesthesia and brain surgery, patients with other therapeutic conditions or who are not in good health may not be its candidates. MVD isn't effective in treating facial pain caused by multiple sclerosis. MVD may not be reasonable for patients who have hearing loss in the other ear.

How is Microvascular Compression Syndrome Diagnosed?

The following set of tests are suggested for a person in whom the diagnosis of microvascular compression is contemplated:

  • Magnetic resonance imaging (MRI) with gadolinium
  • Electroencephalogram (EEG) (if there are paroxysmal symptoms)
  • Electronystagmography (ENG)
  • Audiometry
  • Fluorescent treponemal antigen (FTA),
  • Fasting glucose
  • Auditory Brainstem Response (ABR)

A few tests that are regularly acquired in this circumstance might mislead. MRI/MRA is mainly useful. Generally, this syndrome can't be definitely analysed until the point when a surgical exploration has been done and the patient is healed in-between the follow-ups.

What Happens During MVD? .

There are 5 steps of the procedure. The operation generally takes 2 to 3 hours.

  • Step 1: Preparation In the OR room, general anaesthesia is administered while you lie on the operating table. Once you are asleep, your body is rolled over on its side and your head is set in a 3-pin skull fixation device, which joins to the table and holds your head in a certain position amid the procedure. Next, the area behind your ear is cleaned with an antiseptic solution. A hair-sparing technique might be utilised, where just a 1/4-inch wide zone along the proposed skin entry point is shaved.
  • Stage 2: Perform a Craniectomy A 3-inch curved skin incision is made behind the ear. The skin and muscles are lifted off the bone and folded back. Next, a 1-inch opening is made in the occipital bone with a drill. The bone is removed to expose the protective covering of the brain called the dura. The dura is opened with surgical scissors and folded back to uncover the brain.
  • Stage 3: Expose the Nerve Retractors placed on the brain gently open a path to the trigeminal nerve. The surgeon exposes the trigeminal nerve and identifies any offending vessel causing compression. The vessel and nerve are frequently restricted by thickened connective tissue that must be dissected free with scissors and knife.
  • Stage 4: Insert a Sponge The specialist cuts a fitting size of teflon sponge and inserts it between the nerve and the vessel. At times a vein is adherent to the nerve and causing compression. In these cases, the vein is seared and moved away.
  • Stage 5: Closure Once the sponge is in place, the retractor is removed and the brain comes back to its natural position. The dura is closed with sutures and made watertight with tissue sealant. Since the bone opening is very small, it isn't replaced. Rather, a titanium plate is placed on the skull opening and is anchored with tiny screws. The muscles and skin are sutured together. A soft adhesive dressing is set over the incision.

What Happens after the Surgery?

Once the medical procedure is finished, you will be transferred to the recovery room. You will be closely monitored here by your anaesthesiologist.

Generally, you will spend one night in the Intensive Care Unit. The dressing won't be changed for three days. On the second or third day, the patient is discharged after dressing change and the lumbar drain is pulled.

How is Postoperative Care Done?

You should continue with all preoperative pain medication. Staples/sutures are removed 10 to 14 days after surgery. You may not drive or return to work for around 30 days. Also, you can't wear wigs, colour your hair or other harsh hair products for at least 6 months. These will interfere in long-term healing and you may get infection which could require further surgery.

What are the Risks of Surgery?

Microvascular decompression is an invasive strategy; however, it has potential uncommon risks, including:

  • Infection
  • Cerebrospinal fluid leak
  • Stroke or haemorrhage
  • Excessive bleeding
  • High fever for few days
  • Trouble with speech or swallowing
  • Increase in pain at the surgical site
  • A severe headache not reducing with medication
  • Redness, swelling, drainage or odour from the surgical site
  • Hearing loss, facial numbness, as well as a facial weakness

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Hospitals

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