Ronald Brisman, M.D.
Recently, during a 24 hour period, I spoke to three patients with face pain who either had or were recommended to have a microvascular decompression (MVD) but would have been better managed with either no neurosurgical procedure or a minimally invasive one such as Gamma Knife radiosurgery or needle rhizolysis (radiofrequency electrocoagulation and/or glycerol). One of these patients had a disastrous result from the MVD.
Patient 1: This patient did not have trigeminal neuralgia but rather a neuropathic pain that was continuous, not paroxysmal and not responsive to antiepileptic medicines. He had impairment in more than the trigeminal distribution with decreased sensation not just in the face, but also the entire ear, side of the neck and upper arm. He was advised to have an MVD. The patient did not need an MVD or any other procedure for trigeminal neuralgia.
Patient 2: This 79-year old woman had recurrent trigeminal neuralgia after a previous MVD. She presented to an emergency room. She was hospitalized and treated with a second MVD with subsequent complete numbness on the side of the face that was operated, but also complete deafness in that ear and complete facial weakness that has persisted for more than a year. She would have been better managed with a minimally invasive procedure.
Patient 3: This woman with trigeminal neuralgia had recurrent trigeminal neuralgia pain 3 years after an initial MVD, which she found to be very painful and had required two months to fully recover. She was advised to have another MVD to “explore” the area and was about to have it done, when unexpectedly, while obtaining medical care for an unrelated condition, she found out about the possibility of minimally invasive alternatives. She subsequently saw me and I treated her with Gamma Knife radiosurgery. Repeat MVD is often associated with a greater risk of complications than a first one and a minimally invasive alternative is preferable.Is MVD needed? Sometimes, but often it is not. Get a second opinion with a neurosurgeon who is experienced in the treatment of trigeminal neuralgia including the minimally invasive alternatives.