Microvascular Decompression
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Microvascular decompression (MVD) is a surgical treatment used to relieve facial pain (trigeminal neuralgia), facial spasms (hemifacial spasm), or throat pain (glossopharyngeal neuralgia) when other medical therapies have not been effective. It is a delicate microsurgical procedure in which the neurosurgeon uses an endoscope, exoscope, or operating microscope along with fine instruments to carefully separate blood vessels from affected nerves without damaging nearby structures.
Because of the precision required, experience is critical. At Columbia, MVD is performed by highly experienced cranial nerve surgeons, including Dr. Raymond F. Sekula Jr., who has performed more than 3,000 MVD procedures for trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia.
Dr. Sekula performed an MVD on me 15 years ago. At that time, I was taking 18 pills a day to try to control the pain from trigeminal neuralgia—but it still wasn’t enough. Just yesterday, my husband calculated that I would have taken over 98,000 pills in the past 15 years. The truth is, I likely would not have made it through these years without that surgery.
Trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia are debilitating conditions, which involve cranial nerves. Cranial nerves are 12 pairs of nerves that provide communication between the brain and the face, head and neck. Sometimes small arteries and/or veins irritate these critical nerves by pushing on them. (This anatomical relationship is often referred to as a "neurovascular conflict.") Such pressure can cause a variety of debilitating symptoms, including facial pain, throat pain, ear pain, and facial spasms. Because of the relative rarity of these conditions, many clinicians do not appreciate the inadequacy of medications or botulinum toxin injections in many patients. In other words, many patients suffer unnecessarily because they are not referred to a surgeon.
During MVD, Dr. Sekula separates the blood vessel from the nerve using a variety of techniques, which he has pioneered over the past two decades. Each patient is unique and may require a sling, transposition, or flip technique. Dr. Sekula does not use PTFE felt (often inappropriately referred to as “Teflon”) in his practice. His MVDs are implant-free and organic. The success rate of MVD is very high with the right surgeon.
I had a revision microvascular decompression surgery in 2024. My first MVD was performed elsewhere years ago and did not work. The day I spoke with Dr. Sekula, he immediately arranged all the necessary scans and took my concerns seriously. A few months ago, my husband and I moved to Austria for work. Here we’ve had the chance to travel throughout Europe…so far we’ve been to France, Germany, Czech Republic, and Montenegro. In a real way, this move was made possible with the successful surgery. He is an amazing surgeon and gave me a new lease on life. I have no facial pain, and I was able to go on vacation and enjoy my life without fear of a flare-up.
When is Microvascular Decompression performed?
MVD is most often used in the treatment of trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia.
MVD is a form of brain surgery and can be performed awake or asleep by our team. Our team includes highly experienced and dedicated neuro anesthesiologists. Most often, medications are tried first for a patient, but when medications are ineffective or intolerable, MVD may be an ideal treatment.
How should I prepare for Microvascular Decompression?
Carefully.
Using an operating endoscope, exoscope, or microscope, the surgeon isolates the nerve in trouble and uses a variety of techniques to fix the problem.
How is Microvascular Decompression performed?
Make sure you understand the goals and potential risks of this procedure. It may help to write down your questions as you think of them and bring the list to discuss with your doctor.
Before the procedure, the patient will undergo imaging and other tests, like an audiogram, EMG (electromyogram), BSAEPs (brainstem auditory potentials) MRI (magnetic resonance imaging). Our team utilizes a highly refined MRI protocol to visualize the nerve and blood vessels, which provides a “road map” for possible surgery.
What can I expect after Microvascular Decompression?
Immediately, you can expect some nausea and possibly vomiting. These symptoms resolve within hours to a few days. Most patients feel fully recovered within one month.
Research has shown that experience matters in microvascular decompression surgery. Surgeons who are more experienced performing microvascular decompressions tend to have better outcomes with fewer complications. Patients who are considering microvascular decompression may wish to look for a center, like Columbia's, where the surgeons have extensive experience with the procedure.
How long will I stay in the hospital?
Hospital stay usually requires 1 to 2 days without the need for the intensive care unit.
Will I need to take any special medications?
After surgery, you may be prescribed a brief course of a light narcotic medication for pain control along with acetaminophen and ibuprofen. Narcotic medications can be habit-forming and can have unpleasant side effects, so these are not used indefinitely.
In most patients, preoperative medications, like carbamazepine and oxcarbazepine can be tapered quickly.
Will I need rehabilitation or physical therapy?
Physical therapy is rarely necessary. However, your body will need time to recuperate from surgery. Talk with your surgeon about how much time to expect for your recovery and at what point you will be able to return to normal activities.
Will I have any long-term limitations due to microvascular decompression?
Major complications are fairly rare, but they can occur. Discuss these with your neurosurgeon. Otherwise, no long-term limitations are anticipated.
The pain relief from microvascular decompression is often permanent. A return of the pain, however, may necessitate further surgery.
Patient Stories
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In a 6-week post-surgery interview, Dr. Raymond Sekula speaks with Tulsie Singh who had been suffering from trigeminal neuralgia since 2020. Mr. Singh traveled from Trinidad to Columbia Neurosurgery. Before working with Dr. Sekula, this patient's facial pain was so severe that he could not put a toothbrush in his mouth and medication did not provide relief. Dr. Sekula discusses using microvascular decompression surgery with a hospital stay of mere hours for this man to be completely pain-free four days later and off all medications.
