Question

Microvascular decompression for trigeminal neuralgia. [5]

Hint:

Microvascular decompression offers long-term pain relief and is the most effective surgical option for trigeminal neuralgia when medical therapy fails.

Answer 1

Microvascular decompression (MVD) is a surgical procedure used to treat trigeminal neuralgia, particularly in patients who do not respond to medical management or in those who experience significant side effects from medications.
Step 1: Surgical Technique:
1. Accessing the Trigeminal Nerve: The surgery is performed via a craniotomy, where a small opening is made in the skull near the cerebellum to access the trigeminal nerve root.
2. Decompression: The surgeon identifies the blood vessels compressing the trigeminal nerve and separates them from the nerve using Teflon pledgets or other materials to relieve the pressure.
Step 2: Indications for MVD:
1. Failure of Medical Management: When anticonvulsants and other drugs fail to adequately control the pain or cause intolerable side effects.
2. Good Surgical Candidates: MVD is often more effective in patients with typical trigeminal neuralgia caused by vascular compression, especially those who are relatively young and healthy.
Step 3: Postoperative Care and Outcomes:
1. Recovery Time: Most patients can return to normal activities within a few weeks, but pain relief may take time.
2. Complications: Potential risks include facial weakness, hearing loss, cerebrospinal fluid leaks, or recurrence of neuralgia.