Microvascular Decompression: The Ultimate Fix for Structural Trigeminal Neuralgia


Today I am talking about brain surgery.  It’s a terrifying thought, having someone faff around inside your head, but it’s also an important thought.  Because if you have a blood vessel touching your trigeminal nerve, this could be your ultimate cure.  You could get out of this life, the one where you’re constantly worried about when the next attack is going to hit, the one where you’re avoiding certain foods because you have to chew them a lot, the one where you can’t go out in the wind or the cold because it sets you off.

You could enjoy your life again.

Australian scientists have shown that chronic pain can physically change the brain.  We have lower levels of glutamate, which is a chemical messenger between brain cells and can help regulate emotion.  What this means is brain cells can no longer communicate in their usual way, and so the ability to process positive emotions is reduced.  So that feeling of being tired and unmotivated all the time?  That’s the effects of this change within your brain.

One of the first steps taken to diagnose and categorise your trigeminal neuralgia should be an MRI – with contrast.  This will allow a neurologist to identify any structures that might be touching or compressing the trigeminal nerve – things like blood vessels or tumours – or any damage to the nerve itself.

If you’ve got a blood vessel touching your trigeminal nerve, I’ve got good news for you: you can get microvascular decompression!

Microvascular decompression is a really cool surgery wherein they go in and put a very specialised sponge material between the blood vessel and the nerve where they are touching.  Once they’re no longer touching, there’s no longer a reason for the trigeminal nerve to go off, effectively curing your trigeminal neuralgia.

But it’s brain surgery, and brain surgery is scary!

In most cases, it’s not actually brain surgery.  The blood vessel and the nerve often touch outside of the brain, sometimes within the skull, sometimes outside the skull.  So while they may be entering your skull, they’re not actually touching your brain.  That remains unmolested.

The sponge they insert into your head is a very specialised one.  It’s not like a kitchen sponge, or like a sea sponge, it’s a very special kind of medical sponge, and it’s very very sterile.  Because of course it’s going somewhere bacteria must never go: inside your skull.  It’s also very small.  When you’re working in a confined space, you don’t want to add too much bulk to existing structures, because there’s nowhere for other structures to go.

It’s carefully placed between the blood vessel and the nerve, right where they are touching, and they stitch the sponge onto the blood vessel.  All blood vessels have several layers of tissue, and the stitches are only placed through the outer layers.  The stitches aren’t placed all the way through, so the inside of the blood vessel remains perfectly smooth, and you don’t get any accidental bleeding.

My best friend who has typical trigeminal neuralgia has just undergone this procedure.  She had an artery twisting around her trigeminal nerve and touching it in two places, so she has two sponges in her skull!  She had her surgery on Monday morning.  She went home on Friday.

For now, the right side of her face is numb, because of course the trigeminal nerve has been faffed about with.  She occasionally gets itchy teeth.  But she is pleased to announce she now has complete taste back on the right side of her face!  This numbness is expected, and it’s expected to continue for the next few weeks to the next few months, and she has commented that it’s bearable because she knows it’s only temporary.

She’s also said it is amazing to be free of pain.

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