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Microvascular decompression (MVD) is a surgical procedure that relieves abnormal compression of a cranial nerve. It is performed to treat trigeminal neuralgia, vagoglossopharyngeal neuralgia, and hemifacial spasm. 

MVD is a surgical procedure to relieve the symptoms (pain, muscle twitching) caused by compression of a nerve by an artery or vein. MVD involves surgically opening the skull (craniotomy) and exposing the nerve at the base of the brainstem to insert a tiny sponge between the compressing vessel and the nerve.

This sponge isolates the nerve from the pulsating effect and pressure of the blood vessel. Trigeminal neuralgia is an irritation of the fifth cranial nerve causing severe pain that usually affects one side of the face, normally in the forehead, cheek, jaw, or teeth.

There are 5 steps of the procedure.The operation generally takes 2 to 3 hours.
Step 1: Prepare the patient
In the OR room, general anesthesia is administered while you lie on the operating table.Once asleep, your body is rolled over on its side and your head is placed in a 3-pin skull fixation device, which attaches to the table and holds your head in position during the procedure. Next, the area behind your ear is prepped with antiseptic. A hair-sparing technique may be used, where only a 1/4-inch wide area along the proposed skin incision is shaved.

Step 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,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 expose the brain.

Step 3: Xpose the nerve Retractors placed on the brain gently open a corridor to the trigeminal nerve at its origin with the brainstem.The surgeon exposes the trigeminal nerve and identifies any offending vessel causing compression. The vessel and nerve are often restricted by thickened connective tissue that must be dissected free with scissors and knife.

Step 4: Insert a sponge The surgeon cuts an appropriate size of teflon sponge and inserts it between the nerve and the vessel.Sometimes a vein is adherent to the nerve and causing compression. In these cases, the vein is cauterized and moved away.

Step 5: Closure Once the sponge is in place, the retractor is removed and the brain returns to its natural position. The dura is closed with sutures and made watertight with tissue sealant. Since the bone opening is very small, it is not replaced. Instead, a titanium plate covers the skull opening and is secured with tiny screws.



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