Microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm: Naunces of the technique based on experiences with 100 patients and review of the literature

Microvascular decompression (MVD) surgery for trigeminal neuralgia and hemifacial spasm offers a relatively low-risk opportunity to treat cranial nerve hyperactivity-compression syndromes, which are associated with severe, disabling facial pain and spasm. Although a number of publications have described the technique in detail, combining the technical nuances from different schools of thought or neurosurgical training in an effort to increase the safety and efficacy of this procedure would be beneficial to the surgeon. The nuances of technique and operative findings from performing this procedure for the last 100 cases have been reviewed and combined. The author has reflected on his experience performing microvascular decompression operation. The specifics of operating room set-up, positioning, craniotomy, and intradural microsurgical methods are provided, including managing postoperative care and complications. In the presence of alternative methods of therapy, microvascular decompression operations should be performed with low risk to the patient. There is a learning curve involved with this operation and the surgeon should remain always critical of his/her performance and aspire for a “perfect” result.