Microvascular decompression surgery: surgical principles and technical nuances based on 4000 cases

As an etiological treatment of trigeminal neuralgia (TN) and hemifacial spasm (HFS), microvascular decompression (MVD) has been popularized around the world. However, as a functional operation in the cerebellopontine angle (CPA), this process can be risky and the postoperative outcomes might not be good enough sometimes.

In order to obtain a better result with less complication, this surgery should be further addressed.

With experience of more than 4000 MVDs, we have gained knowledge about the operative technique. Through abundant intraoperative photos, each step of the procedure was demonstrated in detail and the surgical strategy was focused.

The principle of MVD is to separate the nerve-vessel confliction rather than isolate it with prostheses. A prompt identification of the conflict site is important, which hinges on a good exposure. A satisfactory working space can be established by an appropriate positioning of the patient's head and a proper craniectomy as well as a rational approach. A sharp dissection of arachnoids leads to a maximal visualization of the entire intracranial course of the nerve root. All the vessels contacting the trigeminal or facial nerve should be treated. Intraoperative electrophysiological mentoring is helpful to distinguish the offending artery for hemifacial cases.

MVD is an effective treatment for the patient with TN or HFS. Immediate relief can be achieved by an experienced neurosurgeon with good knowledge of regional anatomy. A safe surgery is the tenet of MVD, and accordingly, no single step of the procedure should be ignored.