Brain, Cranial & Nerve
Microvascular Decompression (MVD)
Moving the blood vessel off the trigeminal nerve and keeping it off with a small cushion — a treatment aimed at the cause of trigeminal neuralgia rather than the symptom.
What it is
Microvascular decompression (MVD) treats trigeminal neuralgia at its source. Through a small opening behind the ear, under the operating microscope, we follow the trigeminal nerve to the point where a blood vessel — usually an artery — is pulsing against it at the brainstem. The vessel is gently mobilized off the nerve, and a small Teflon cushion is placed to keep it away permanently.
The nerve is not cut, burned, or injected. Nothing is destroyed. That is the defining difference between MVD and every other treatment for this condition: the procedures that damage the nerve trade pain relief for facial numbness; MVD addresses the compression and leaves the nerve intact.
Why this procedure when surgery is needed
For classic trigeminal neuralgia caused by vascular compression, MVD is the option that treats the compression itself and leaves the nerve intact, rather than damaging the nerve to interrupt the pain signal. The intent is to leave facial sensation intact.
The honest trade-off is that MVD is the most invasive of the options — a small cranial operation rather than a needle or focused radiation. For healthy patients with medication-refractory classic trigeminal neuralgia and vascular compression on imaging, that trade is usually worth making, and we will tell you plainly when we think it is not.
What to expect
Surgery typically takes 2–3 hours.
Hospital stay of 2–3 nights.
Many patients wake with the facial pain gone; for some, relief settles in over days to weeks.
Headache and incisional soreness behind the ear for the first weeks are the main early symptoms.
Back to light activity in 2–3 weeks; most normal activities by 4–6 weeks.
Trigeminal neuralgia medications are tapered after surgery rather than stopped abruptly — we guide the schedule.
Risks and what to expect
MVD works in a small corridor shared by the nerves for hearing, facial movement, and balance — the risks below are uncommon, and the monitoring and technique of the operation are built around them.
Expected, temporary effects
Headache and incisional soreness. Headache and soreness behind the ear are the dominant early symptoms and settle over the first weeks.
Nausea, dizziness, and fatigue. Operating near the balance structures commonly causes a few days of unsteadiness or nausea, which resolves as the brain adjusts.
Serious risks
Hearing loss. The hearing nerve is the closest neighbor in the surgical corridor; hearing on that side can be reduced or, uncommonly, lost. Hearing is monitored continuously during surgery to protect it.
Facial numbness or weakness. Numbness in the face or weakness of facial movement can occur and is usually temporary; lasting deficits are uncommon — and avoiding numbness is precisely why MVD is chosen over nerve-destroying procedures.
CSF leak. Spinal fluid can leak through the incision or into the ear space, sometimes requiring further treatment; meticulous closure reduces this risk.
Recurrence of pain. Pain can return years later in a minority of patients; options remain if it does.
Stroke or cerebellar injury. Injury to vessels or the cerebellum in the surgical corridor is rare but serious.
Infection. Wound infection or, rarely, meningitis can occur and is minimized with sterile technique and antibiotics.
Prepare and recover
Handouts that fit this surgery. Always follow your own surgeon's specific protocol.
Recover from this surgery
Approach
- High-resolution MRI before surgery to visualize the vessel-nerve conflict
- Small retrosigmoid opening behind the ear
- Operating microscope for the entire intracranial portion
- Vessel mobilized and a Teflon cushion secured between vessel and nerve
- Intraoperative monitoring of hearing and facial nerve function throughout
- Meticulous closure to minimize spinal fluid leak risk
Typical indications
- Classic trigeminal neuralgia — brief, electric, trigger-provoked facial pain
- Vascular compression of the trigeminal nerve on high-resolution MRI
- Pain refractory to medication, or intolerable medication side effects
- Patients healthy enough for a cranial operation, favoring durable relief without facial numbness
- Recurrence after a prior needle-based or radiation procedure, in select cases
A second opinion can help you understand the recommendation in front of you and prepare better questions before deciding.
Request a Second OpinionAlternatives we considered
- Medication — carbamazepine or oxcarbazepine — which is always the first-line treatment
- Stereotactic radiosurgery to the nerve: non-invasive, with relief that develops over weeks and facial numbness among its trade-offs
- Percutaneous procedures (balloon compression, glycerol, radiofrequency): needle-based options that intentionally injure the nerve, useful when surgery is not appropriate
- Continued medical management when pain is controlled and side effects are tolerable
The information on this page is general patient education and is not a substitute for individualized medical advice. For urgent symptoms, call 911 or go to the nearest emergency department. For non-urgent questions, call (785) 368-0767 during clinic hours.
Not sure whether a symptom needs a call? When to call after surgery