Trigeminal Neuralgia MVD
Microvascular Decompression (MVD) is the most effective and durable surgical treatment for trigeminal neuralgia, a condition characterized by agonizing, shock-like facial pain. Through a small incision behind the ear, the neurosurgeon performs a craniotomy to access the trigeminal nerve at the brainstem. Using an operating microscope, the surgeon identifies the blood vessel compressing the nerve and places a tiny Teflon felt pad between them, permanently relieving the compression and curing the facial pain.
When this procedure may be recommended
- Classic trigeminal neuralgia causing severe, debilitating facial pain.
- Failure of medical management (e.g., carbamazepine, gabapentin) or intolerable drug side effects.
- MRI evidence of neurovascular compression (a blood vessel pressing on the trigeminal nerve).
Who may be a candidate
MVD is highly successful and is the gold standard for patients who are medically fit for general anaesthesia and present with classic trigeminal neuralgia. It is particularly favoured because it treats the underlying cause without damaging the nerve, preserving normal facial sensation.
Advanced medical implant technology (no text). Alternatives to surgery
- Ongoing neuropathic medication adjustments.
- Stereotactic radiosurgery (Gamma Knife) to scar the nerve root (non-invasive, but higher rate of pain recurrence).
- Percutaneous glycerol rhizotomy, balloon compression, or radiofrequency ablation (needle-based procedures through the cheek).
What to expect
- Anaesthesia & Approach: Under general anaesthesia, a small vertical incision is made behind the ear on the side of the facial pain.
- Keyhole Craniotomy: A small window (about the size of a 50-cent coin) is made in the skull behind the ear, exposing the protective membrane (dura).
- Nerve Exposure: The surgeon opens the dura and uses an operating microscope to carefully navigate around the cerebellum to expose the trigeminal nerve where it exits the brainstem.
- Vessel Dissection: The compressing artery or vein is meticulously dissected and separated away from the nerve.
- Decompression: A small, soft Teflon felt pad is inserted between the blood vessel and the nerve, acting as a permanent shock absorber.
- Closure: The bone window is covered, and the muscles and skin are sutured closed.
Technology and imaging
Performed using high-definition surgical microscopes, micro-dissection instruments, and intraoperative brainstem auditory evoked response (BAER) monitoring to protect hearing nerves.
High-precision diagnostic imaging visualization. 
Clinical Zeiss/Leica operating microscope setup. Hospital stay
Typically 2 to 3 nights in hospital, with rapid recovery.
Recovery milestones
- Day 1: Mobilising on the ward. Facial pain is typically gone immediately after waking up.
- Weeks 1-4: Home rest. Expect mild neck stiffness, temporary dizziness, or fatigue. Stitches are removed at 10-14 days.
- Medication Tapering: Pre-operative neuropathic pain medications are gradually and safely tapered down over several weeks under medical guidance.
Post-operative mobilization and recovery milestones. Risks and complications
- Aseptic meningitis or chemical headache (transient neck stiffness, managed with steroids).
- Hearing loss on the operated side (1% to 2% risk due to proximity to the acoustic nerve).
- Facial numbness or weakness (rare with MVD compared to other treatments).
- Cerebrospinal fluid leak requiring stitch adjustment or lumbar drain (1% to 2% risk).
Frequently asked questions
How quickly does MVD relieve the pain?
The facial pain is typically completely gone immediately upon waking up from the surgery. Some patients may experience mild, transient twinges as the nerve heals, but the severe electric shocks are relieved.
What is the long-term success rate of MVD?
MVD has the highest long-term success rate of all trigeminal neuralgia treatments, with approximately 80% to 90% of patients remaining completely pain-free and off all medications at 5 to 10 years follow-up.