Microvascular Decompression
What is Microvascular Decompression ?
.
Why do you need Microvascular Decompression ?
MVD is indicated for:
- Trigeminal neuralgia (TN): Most common, causing severe, electric-shock-like facial pain due to trigeminal nerve compression (usually by the superior cerebellar artery).
- Hemifacial spasm (HFS): Involuntary facial muscle twitching, often due to facial nerve compression (e.g., by the anterior inferior cerebellar artery).
- Glossopharyngeal neuralgia (GPN): Rare, causing throat/ear pain from glossopharyngeal nerve compression.
- Other cranial nerve disorders (rare): Geniculate neuralgia (ear pain) or vertigo/tinnitus from vestibulocochlear nerve compression.
- Failed medical treatment: Persistent symptoms despite medications (e.g., carbamazepine for TN, botulinum toxin for HFS).
- Younger patients: MVD is preferred over destructive procedures (e.g., radiofrequency ablation) for long-term relief in patients <65 years.
The procedure aims to provide long-term pain relief or symptom control (e.g., spasms) by relieving nerve compression, with a high success rate for TN (80–90% initial relief).
Why Do Microvascular Decompression Costs Vary in Philippines?
.
Microvascular Decompression Procedure
- Before Surgery Evaluation:
- Diagnosis:
- MRI with FIESTA/CISS sequence: Visualizes the nerve-vessel conflict (e.g., trigeminal nerve compression).
- Clinical history: Confirms typical symptoms (e.g., unilateral, episodic facial pain in TN; twitching in HFS).
- Neurological exam: Rules out other causes (e.g., tumors, multiple sclerosis).
- Blood tests: Ensure fitness for surgery (e.g., coagulation, hemoglobin).
- Medications: Pain relief (e.g., carbamazepine for TN); may be stopped pre-surgery to assess baseline symptoms.
- Consent: Risks, including hearing loss or CSF leak, are explained.
- Diagnosis:
- Surgical Techniques:
- Retrosigmoid Craniotomy:
- Performed under general anesthesia, lasting 2–4 hours.
- The patient is positioned laterally or sitting (surgeon preference).
- A small incision (3–5 cm) is made behind the ear (retrosigmoid approach).
- A craniotomy (2–3 cm) exposes the cerebellum and cranial nerves.
- The cerebellum is gently retracted to access the nerve (e.g., trigeminal, facial).
- The compressing vessel is identified using a microscope.
- The vessel is mobilized, and a Teflon pad (or muscle/fat graft) is placed between the nerve and vessel to prevent further compression.
- The dura is closed, the bone flap is replaced (or a titanium mesh is used), and the incision is sutured.
- Intraoperative Tools:
- Microscope: Enhances visualization of small structures.
- Neuromonitoring: Tracks cranial nerve function (e.g., brainstem auditory evoked potentials for hearing preservation).
- Endoscope (sometimes): Assists in visualizing hidden areas.
- Retrosigmoid Craniotomy:
- After Surgery:
- ICU monitoring for 1–2 days to watch for swelling, bleeding, or CSF leaks.
- Hospital stay: 3–5 days.
- Pain management: Analgesics (e.g., paracetamol) for incision pain; TN pain relief is often immediate.
- Antibiotics (e.g., cefazolin) for 1–2 days to prevent infection.
- Follow-up MRI: At 3–6 months to confirm vessel-nerve separation.
Recovery After Microvascular Decompression
- Hospital Stay: 3–5 days; longer (5–7 days) if complications.
- Post-Surgery Care:
- Pain: Scalp discomfort for 1–2 weeks, managed with analgesics; TN pain relief often immediate, HFS relief may take weeks.
- Activity: Light walking on day 1–2; avoid heavy lifting or straining for 6–8 weeks.
- Wound care: Keep incision dry for 7–10 days; sutures/staples removed at 10–14 days.
- Neurological monitoring: For hearing, facial movement, or new deficits; HFS spasms may persist briefly due to nerve irritation.
- Diet: Normal diet; high-protein foods (e.g., eggs, lentils) support healing; 2–3 liters water daily.
- Follow-Up:
- Visits at 2 weeks, 6 weeks, and 3 months; MRI at 3–6 months.
- Neurological assessment for symptom relief or complications.
Most resume normal activities in 6–8 weeks. Success rates: TN (80–90% initial pain relief, 70% at 10 years); HFS (85–95% spasm relief); GPN (80–90% pain relief). Recurrence rates: 10–20% over 10 years.
Risks and Complications
- Surgical Risks: Bleeding (1–3%), infection (1–3%), CSF leak (3–5%).
- Neurological Complications:
- Hearing loss (2–5%): Due to cochlear nerve injury (more common in HFS).
- Facial weakness (1–2%): Temporary or permanent (esp. in HFS surgery).
- Numbness (TN, 2–5%): From trigeminal nerve manipulation.
- Cerebellar injury (1–2%): Ataxia or balance issues.
- General Risks: Anesthesia reactions, blood clots (DVT, 1–2%).
- Long-Term:
- Symptom recurrence (10–20%): Vessel re-compression or new vessel contact.
- Chronic headache (2–5%): At incision site.
Report fever, severe headache, CSF leak (clear fluid from incision/ear), or hearing loss promptly.
Frequently Asked Questions (FAQs)
What causes trigeminal neuralgia or hemifacial spasm?
Usually vascular compression (e.g., artery pressing on the nerve); rarely tumors, multiple sclerosis, or trauma.
Can symptoms be treated without surgery?
Yes, initially with medications (e.g., carbamazepine for TN, botulinum toxin for HFS); MVD is for failed medical treatment.
Is MVD a permanent cure?
Often, with 70–80% long-term relief; 10–20% may have recurrence over 10 years.
How soon can I resume activities?
Light activities in 1–2 weeks, normal routines in 6–8 weeks.
Is MVD covered by insurance in India?
Yes, for symptomatic TN, HFS, or GPN; confirm with your provider.
Signs of complications?
Fever, severe headache, CSF leak, hearing loss, or facial weakness.
Will I lose facial sensation or movement?
Risk exists (1–5%); neuromonitoring minimizes this, and most deficits are temporary.
Lifestyle changes post-surgery?
Avoid heavy lifting for 6–8 weeks, attend follow-ups, and monitor for symptom recurrence.
Conclusion
.
Looking for Best Hospitals for Microvascular Decompression
Note: we are not promoting any hospitals
We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₱) | Maximum Price (₱) |
|---|---|---|
|
Angeles City |
|
|
|
Antipolo |
|
|
|
Bacolod |
|
|
|
Bacoor |
|
|
|
Baguio |
|
|
|
Butuan |
|
|
|
Cagayan de Oro |
|
|
|
Caloocan |
|
|
|
Cebu City |
|
|
|
Dasmariñas |
|
|
|
Davao City |
|
|
|
General Santos |
|
|
|
General Trias |
|
|
|
Iligan |
|
|
|
Iloilo City |
|
|
|
Las Piñas |
|
|
|
Makati |
|
|
|
Malolos |
|
|
|
Manila |
|
|
|
Muntinlupa |
|
|
|
Parañaque |
|
|
|
Pasay |
|
|
|
Pasig |
|
|
|
Puerto Princesa |
|
|
|
Quezon City |
|
|
|
San Fernando |
|
|
|
San Jose del Monte |
|
|
|
Taguig |
|
|
|
Valenzuela |
|
|
|
Zamboanga City |
|
|
Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.