This procedure is the only one that gets to the presumed cause of trigeminal neuralgia in most people, which is pressure exerted on the trigeminal nerve by a blood vessel near the nerve’s exit site from the brain. This surgery has the potential benefit of relieving pain without causing numbness in the face, and it may have better long-term success compared to other surgical treatments. However, since it is major surgery, it requires hospitalization and a longer recovery time.
Microvascular decompression surgery is performed under general anesthesia. An incision is made behind the ear on the side where the pain originates. A small opening is made in the skull and the brain is gently lifted to expose the trigeminal nerve. The surgeon then looks for a blood vessel pinching the trigeminal nerve next to the brain. If it is found, it is moved away from the nerve. A small amount of padding material is then inserted between the blood vessel and the nerve to cushion and protect the nerve from pressure.
Although uncommon, microvascular decompression can cause hearing impairment, facial weakness and numbness, double vision and stroke.