Microvascular Decompression (MVD)
Microvascular decompression is a microsurgical procedure based on separating a blood vessel that is compressing a cranial nerve and placing a soft cushion between them. It is most often used for conditions caused by neurovascular contact, such as trigeminal neuralgia and hemifacial spasm.
最終更新: 2026-06-08
Definition
Microvascular decompression (MVD) is a procedure in which a blood vessel (usually an artery, sometimes a vein) compressing the root-entry zone of a cranial nerve at the brainstem is gently moved away from the nerve under the operating microscope. An inert cushion, such as a Teflon (polytetrafluoroethylene) pad, is placed between nerve and vessel to eliminate the contact permanently. The aim is to remove the source of nerve irritation and thereby relieve the underlying symptoms.
Indications
The most common indication is classic trigeminal neuralgia associated with contact between a vessel and the trigeminal nerve (fifth cranial nerve). It is also used in hemifacial spasm, marked by involuntary twitching of one side of the face, when there is compression of the facial nerve (seventh cranial nerve). Less commonly it is used for glossopharyngeal neuralgia. MVD is generally considered in patients who gain insufficient benefit from medication or cannot tolerate drug side effects and in whom imaging supports neurovascular contact.
Method
The procedure is performed under general anesthesia. A small retrosigmoid craniotomy behind the ear is used to reach the cerebellopontine angle, where the relevant cranial nerve exits the brainstem. After cerebrospinal fluid is released and the cerebellum is gently retracted, the vessel compressing the nerve is identified. The vessel is separated from the nerve and a Teflon cushion is interposed. In some centers, auditory and facial nerve function is followed with neuromonitoring during the operation.
Advantages and Limitations
Because MVD is the only approach that aims to remove the cause without destroying the nerve, in suitable cases it has the potential to provide durable relief without facial sensory loss. On the other hand, it is an open posterior-fossa operation requiring general anesthesia, and not every patient is a candidate. With advanced age, comorbidities, or when imaging fails to show clear neurovascular contact, alternatives such as balloon compression, glycerol rhizotomy or stereotactic radiosurgery may be considered.
Recovery and Risks
Patients are usually monitored in hospital for a few days, and most return to daily activities within a few weeks. Potential risks include hearing loss, facial weakness or sensory change, cerebrospinal fluid leak, meningitis, bleeding and stroke. Symptoms may recur after treatment. No outcome is guaranteed; decisions are individualized.
参考文献
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:1795-1800.
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1870-1872.
- Barker FG, et al. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996.
- Bendtsen L, et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019.
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