What is MVD?
Microvascular Decompression Surgery (MVD) is a surgical procedure which involves the opening of the skull to expose the nerve at the base of the brainstem. Then, a tiny sponge is inserted between the vessel and the nerve, which creates a space between the two. This leads to protection of the nerve from pulsation and pressure of the adjacent blood vessel. The surgery is used to relieve the abnormal compression of cranial nerves that causes trigeminal neuralgia, glossopharyngeal neuralgia, and hemifacial spasm.
Who is recommended to get the surgery done?
Patients with the following cases are recommended to have a microvascular decompression surgery:
Facial pain specifically in the ophthalmic division of the trigeminal nerve.
Recurrent facial pain after a radiosurgery or percutaneous procedure.
Trigeminal neuralgia, which cannot be treated with medications.
Before the surgery
Before the surgery, the patient is asked to go through a number of tests that include certain blood tests, electrocardiogram, chest x-ray, etc. Medical history is taken to rule out any allergy or past illness. The patients are also asked to stop taking any NSAIDs one week before the surgery, and also stop smoking and chewing tobacco. Lastly, it is also advised to wash the head with chlorhexidine antiseptic soap for 3 days before the surgery.
During the surgery
Firstly, general anesthesia is administered while the patient lies on the operating table. The head is placed in a 3-pin skull fixation device to fix the head with the table. The area behind the ear is prepared with antiseptic and an incision is made.
A 3-inch curved incision is made behind the ear followed by lifting the skin and muscles from the bone. Then, an opening is made in the occipital bone with a drill. Later, the dura is opened with surgical scissors and folded back to expose the brain.
After placing the retractors, the nerve is exposed and the vessel causing the compression is identified. A thick connective tissue is present that restricts the blood vessel and the nerve which must be dissected free.
A Teflon sponge is cut in an appropriate size and inserted between the nerve and the vessel.
Once the sponge is placed, the retractor is removed. The dura is closed with sutures along with the use of an airtight sealant. A titanium plate is used to cover the bony opening. The muscles and skin are sutures back.
After the surgery
After the surgery is completed, the patient is taken to the recovery room to monitor all the vital signs. Then he/she is taken to the ICU for better observation. It usually takes 1-2 days for the patient to stay in the hospital. During this time, he/she may suffer from nausea and headache. The success rate of microvascular decompression surgery is around 95% with a low risk of recurrence of pain. There is no facial numbness, unlike percutaneous stereotactic rhizotomy. General complications include bleeding, infection, blood clots, and specific complications include nerve damage, swelling in the brain, CSF leak, venous sinus occlusion, hoarseness, hearing loss, etc.
To know the best neurosurgery hospitals in India, click here.