Microvascular decompression surgery for chronic neuralgia

Continue from the last article of craniotomy for meningeal tumors, the author will talk about the treatment of Trigeminal Neuralgia, Glossopharyngeal Neuralgia and Hemifacial Spasm surgeries.

Trigeminal neuralgia, glossopharyngeal neuralgia, and hemifacial spasm are all in group of cranial nerve sensory or motor function disorders. Under the human skull, there are 12 nerves in the brain stem. The fifth nerve is the trigeminal nerve responsible for the facial expression, the ninth glossopharyngeal nerve is responsible for the sensation of the mouth, tongue and throat, and the seventh is for controlling our eyes. When these nerves at the base of the skull are stressed and it will send out abnormal nerve impulse which leading to have pain in the face, tongue and throat, or even involuntary spasm and twitching of the eye and facial muscles. Stress may lead to brain tumors, but in most cases due to various factors such as high cholesterol, high blood pressure, diabetes, smoking, clogging of the blood vessels, brain nerves or blood vessels inflammation. When the heart pumping blood, the pulse of the cerebrovascular stimulates the nerve causing it to involuntarily send out false messages, causing pain or muscle twitching symptoms. Every time the blood vessel pulses, the patient’s face, teeth, or jaw will experience twitches and severe pain. When all medications, non-invasive, and non-surgical treatments cannot effectively relief the patient’s symptoms, microvascular decompression surgery may be an option to cure the illness.

Case Sharing：

Ms. Zhang suffering from trigeminal neuralgia

This 88-year-old Ms. Zhang is a patient with trigeminal neuralgia. At first, Ms. Zhang thought it was a toothache, but after the dentist removed the suspected tooth, the pain continued to occur. She was diagnosed with trigeminal neuralgia.

For more than ten years whenever she suffers from this illness, her face feel severe nerve pain. Trigeminal neuralgia can be induced by brushing teeth, washing face, eating, talking, or even touching the face slightly. Ms. Zhang described neuralgia to be even more painful than childbirth. The day and night pain also affected her social life and causing her depress.

In the early stage of the illness, doctors usually use drugs to control the condition. As the years pass, the condition begins relapse and worsen, and the effectiveness of the drugs gradually disappears. In this situation, the dosage of the drugs for the patient will increase and more analgesics medication must be taken. However, these drugs can cause side effects such as dizziness, confusion, drowsiness, and unstable movements. When the condition gradually deteriorates with years, the side effects of the drugs also significantly affect daily life. At this time, minimally invasive neurosurgery is one of the best options for the patient.  For many years, the symptoms have disrupted her speech, ability to swallow food, and daily self-care abilities. The strongest nerve analgesics are no longer of use even if the amount of the medicine is increased. It will only bring serious side effects, causing Ms. Zhang to become drowsy, dizzy and unsteady.

Microvascular decompression surgery relieves Ms. Zhang’s years of suffering

When I first consulted Ms. Zhang in the clinic, she had severe right facial nerve pain, and her symptoms were so extreme that she could not even raise her voice. The long-term pain also made her depress, so after considering other non-surgical treatment options (Such as radiofrequency therapy, radiation therapy, brain magnetic stimulation therapy, etc.),Ms. Zhang and her family requested immediate microvascular decompression surgery.

Microvascular Decompression MVD is to cure pain. The operation must be performed under a microscope. The doctor will carefully use a minimally invasive brain surgical instrument to separate the vascular ring from the compressed nerve of the skull base with a deviation of less than one millimeter, and then implant artificial fiber material, used to separate blood vessels and nerve, it’s like adding a protective cushion in front of nerve to resist the impact of the blood vessel ring on the nerves when the heart beats.

Most patients have no symptoms after the operation and do not need to continue taking nerve analgesics. They can enjoy life with a cheerful mood. On the day when the operation was completed, Ms. Zhang realized that the pain in the right facial nerve had disappeared after she woke up from the anesthesia, and she was finally able to smile! The day after the operation, Ms. Zhang was discharged from the hospital and went home. For many years, she has enjoyed a normal life without pain and does not need to take medication again!