What is the role of microvascular decompression (MVD) in the treatment of trigeminal neuralgia (TN)?

Updated: Jul 11, 2019
  • Author: Manish K Singh, MD; Chief Editor: Robert A Egan, MD  more...
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Answer

Jannetta pioneered microvascular decompression (MVD). This procedure is commonly performed in younger, healthier patients, especially those with pain isolated to the ophthalmic division or in all 3 divisions of the trigeminal nerve and in those with secondary trigeminal neuralgia (TN). It is now the most common surgery performed for trigeminal neuralgia and general anesthesia is required.

Microvascular decompression consists of opening a keyhole in the mastoid area and freeing the trigeminal nerve from the compression/pulsating artery; then, a piece of Teflon is placed between them. Large series have been published, and the initial efficacy is greater than 80%. Recurrence rates are among the lowest (20% at 1 year, 25% at 5 years) compared with other invasive treatments. [54, 53] Usually, it requires the demonstration of true contact and compression by the artery on the nerve, but series are published that show an almost equally effective result without any demonstrated abnormality on imaging or even frank compression shown preoperatively. A 2015 systematic review and meta-analysis found that MVD had a significantly higher rate of initial pain-free outcomes (BNI grade 1) and a significantly lower pain-free recurrence rate when compared with GKS. [55]

See a surgical image below.

Microvascular decompression (Jannetta procedure) u Microvascular decompression (Jannetta procedure) used to treat trigeminal neuralgia. The anteroinferior cerebellar artery and the trigeminal nerve are in direct contact. Courtesy of PT Dang, CH Luxembourg

Patients spend 4-10 days in the hospital and another week convalescing at home. Thus, recovery is more prolonged than with percutaneous procedures. In addition, mortality for this more invasive procedure approaches 0.5%. Serious morbidity includes dizziness, temporary facial palsy, cerebrospinal fluid leaks, meningitis, cerebellar stroke, and hearing loss, which may occur in 1-5% of cases.

Also see Trigeminal Neuralgia Surgery.


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