Microvascular decompression

Microvascular decompression (MVD), also known as the Jannetta procedure, is a neurosurgical procedure used to treat trigeminal neuralgia, a pain syndrome characterized by severe episodes of intense facial pain, and hemifacial spasm. The procedure is also used experimentally to treat tinnitus and vertigo caused by vascular compression on the vestibulocochlear nerve. Microvascular decompression (MVD), also known as the Jannetta procedure, is a neurosurgical procedure used to treat trigeminal neuralgia, a pain syndrome characterized by severe episodes of intense facial pain, and hemifacial spasm. The procedure is also used experimentally to treat tinnitus and vertigo caused by vascular compression on the vestibulocochlear nerve. Nicholas Andre first described trigeminal neuralgia in 1756. In 1891 Sir Victor Horsley proposed the first open surgical procedure for the disorder involving the sectioning of preganglionic rootlets of the trigeminal nerve. Walter Dandy in 1925 was an advocate of partial sectioning of the nerve in the posterior cranial fossa. During this procedure he noted compression of the nerve by vascular loops, and in 1932 proposed the theory that trigeminal neuralgia was caused by compression of the nerve by blood vessels, typically the superior cerebellar artery. With the advent of the operative microscope, Peter J. Jannetta was able to further confirm this theory in 1967 and advocated moving the offending vessel and placing a sponge to prevent the vessel from returning to its native position as a treatment for trigeminal neuralgia. Patients most likely to benefit from a microvascular decompression have a classic form of trigeminal neuralgia. The diagnosis of this disorder is on the basis of the patients' symptoms and from a neurological examination. No blood test or genetic marker exists to diagnose the disease. An MRI scan can help eliminate other diagnoses. Newer MRI techniques may allow for the visualization of vascular compression of the nerve. Patients who improve with an MVD are likely to have pain which is episodic rather than constant. The pain typically has an electrical quality to it and is intense. The pain can usually be triggered. Common triggers include light touch, eating, talking or putting on make-up. Most patients whose face pain improved with an MVD also improved at least temporarily with medication.