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Microvascular Decompression for Trigeminal Neuralgia

Microvascular Decompression for Trigeminal Neuralgia at NYU Winthrop Hospital

Innovative trigeminal neuralgia surgery providing the best potential for relief from pain

Trigeminal neuralgia is a neuropathic disorder of the trigeminal nerve that results in intermittent severe facial pain. Over time, it can lead to serious anticipatory anxiety, depression and life-threatening malnutrition. Trigeminal neuralgia usually results when a small blood vessel compresses the fifth cranial nerve, applying pressure where the nerve joins the brain stem. In patients with multiple sclerosis, trigeminal neuralgia is caused by demylenation of the trigeminal pathways. In rare cases, the condition can be caused by a mass, such as a tumor compressing the trigeminal nerve.

Most trigeminal neuralgia sufferers get temporary help from pain relievers or anticonvulsant medications. However, over time, the pain attacks can become more frequent and severe, requiring higher dosages and more continuous usage of medication. If patients cannot tolerate medication because of side effects, or continue to have pain despite medication, surgical intervention is indicated. For patients who are young, healthy, and do not have MS, microvascular decompression for trigeminal neuralgia is the recommended surgical treatment option.

What Is Microvascular Decompression for Trigeminal Neuralgia?

Microvascular decompression for trigeminal neuralgia is as surgical procedure to remove the identified cause of the condition by relocating or removing the blood vessel pressing on the nerve and causing the pain. The procedure does not damage or destroy any part of the trigeminal nerve and is 95% effective, with a low risk of pain recurrence and minimal side effects. Microvascular decompression provides the best potential for long-term relief or cure of trigeminal neuralgia pain.

An Innovative Treatment Providing Immediate Pain Relief

During the procedure, which takes about two to three hours and requires general anesthesia, a quarter-sized hole is made behind the ear on the side of the face that is painful. The surgeon enters the skull through the opening, and with the aid of an operative binocular microscope to magnify the field, the brain is carefully retracted to expose the trigeminal nerve. If an artery is found in contact with the nerve root, it is directed away, and a tiny Teflon cushion-like pad is placed between the nerve and the vessel. The pad isolates the nerve from the pulsating effect and pressure of the artery. If a vein is compressing the nerve, it is removed.

Pain relief is typically instantaneous with microvascular decompression for trigeminal neuralgia, and after a brief hospitalization, patients are discharged requiring no further medications.

Our Trigeminal Neuralgia Surgery Team

Michael Brisman, MD, FACS
Chief, Division of Neurosurgery

Jeffrey Brown, MD, FACS
Neurosurgery Director of Cyberknife Program

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