Microvascular decompression (MVD)

Microvascular decompression (MVD) is a surgery used to treat severe facial pain or spasms caused by enlarged blood vessels that put pressure on the cranial nerves. Conditions commonly treated with MVD include trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. MVD, also known as the Jannetta procedure, is typically recommended in cases where symptoms are not resolved with conventional treatments or medications.

When performed by experienced neurosurgeons, MVD can provide long-lasting pain relief without nerve damage. Our neurosurgeons at Penn Medicine are skilled at navigating the complex anatomy of cranial nerves and blood vessels to perform this intricate procedure with precision and care.

Microvascular decompression surgery is recommended for patients under age 65 and in good health with minimal medical risks. Your doctor might also recommend MVD surgery if you: 

• Have been diagnosed with trigeminal neuralgia, hemifacial spasm, or glossopharyngeal neuralgia 
• Have taken medication or nerve block treatments that were unsuccessful in addressing your symptoms 

Microvascular decompression surgery is typically completed in two to three hours. Here’s what you can expect during surgery:

• Under general anesthesia, you’ll be positioned on an operating table where your care team will prepare you for the procedure. They will apply antiseptic to the area behind your ear and may need to shave some of your hair to give the surgeon clear access to the problem area.
• Your surgeon will make a small incision behind your ear before drilling a small opening in the skull to expose the dura, the protective covering of the brain.
• Next, your surgeon will work to remove any thickened connective tissue to expose the nerve and identify the enlarged blood vessels.
• A Teflon sponge will be custom-fitted and carefully placed between the nerve and the compressing blood vessels.
• After confirming the sponge has been properly placed, your surgeon will close the dura, place a titanium plate over the skull opening and apply stitches to close the incision. 

After microvascular decompression, patients typically remain in the hospital for two to five days post-surgery. This allows your care team to monitor for any recurrence of symptoms. Pain relief after microvascular decompression surgery is usually immediate.  

You can take steps to ensure a smooth recovery: 

• Follow your doctor’s instructions about how to care for your incision. You may be advised to gently wash the area but avoid submerging it in water.
• You may experience headaches and some discomfort that you can manage with acetaminophen or prescribed pain medication. Your doctor may also prescribe anti-seizure medication.
• Avoid smoking or drinking alcohol. These substances can interfere with pain medications, increase the risk of bleeding, and delay your incision healing.
• Initially, you’ll want to avoid heavy lifting, physical activities, and driving. Your doctor will advise you on how to gradually increase physical activity, but you can expect to avoid strenuous activities for about six weeks. Most patients return to full activities within a few months. 

Microvascular decompression is considered a safe and effective procedure. However, as with any surgery, there is a small chance of risks. Our care team will be there to discuss these risks with you and answer any questions you have so you feel comfortable moving forward with the procedure. You can trust that our experienced neurologists at Penn Medicine will take all necessary precautions to minimize these risks and perform your microvascular decompression procedure with the utmost precision. 

Potential risks include: 

• Facial numbness or weakness 
• Hearing loss 
• Infection 
• Nerve damage 
• Problems with speech or difficulty swallowing 
• Stroke  

Penn Medicine has a proud tradition of developing innovative methods for treating cranial nerve disorders. Following in the footsteps of Peter Jannetta, MD, a University of Pennsylvania graduate who developed the MVD procedure, our neurosurgeons have continued pioneering advancements to cranial nerve treatments, helping to ensure the best outcomes for patients living with debilitating facial neuralgias. Our experienced surgeons strive to achieve the best possible outcome for every patient.