Current Status of Microvascular Decompression for Trigeminal Neuralgia in our Department

Microvascular decompression (MVD) has spread worldwide as a treatment for trigeminal neuralgia (TN) and is a standard surgical procedure.In our department, the number of such surgeries has been increasing, and we are one of the facilities in Japan that performs many of these procedures.In this report, we introduce the modifications and practical aspects of this surgery for TN.Magnetic resonance imaging (MRI) is useful as a preoperative examination, and three-dimensional magnetic resonance cisternogram/ angiogram fusion images enable detailed and accurate visualization of the three-dimensional compression of nerves and blood vessels.Hearing loss is a potential surgical complication; however, we monitor the auditory brainstem responses intraoperatively as a preventive measure.To prevent cerebrospinal fluid leakage, we meticulously suture the dura mater and use fibrin glue to close the epidural space.Surgery is divided into transposition, which involves significantly moving blood vessels, and interposition, which involves the insertion of a prosthesis between the blood vessels and nerves.The choice between these two methods is made by selecting an appropriate approach based on the actual surgical field.Additionally, in cases with severe adhesions or no vascular compression, internal neurolysis involving a longitudinal incision of the epineurium of the trigeminal nerve has yielded favorable outcomes.The surgical results have shown no major complications, with more than 95% of patients experiencing symptom disappearance or improvement.Owing to the nature of MVD, which is intended to treat functional disorders, such as TN, a detailed preoperative evaluation, advanced techniques, and intraoperative monitoring are required before surgery.However, surgery is the fundamental treatment for this disorder and should be aggressively considered.