for microvascular decompression of the trigeminal nerve is
done to treat trigeminal neuralgia. Trigeminal neuralgia
is characterized by severe spasmodic episodes of lancinating
pain which travels to one side of the face. Often it
is related to an artery (the superior cerebellar artery) compressing
the trigeminal nerve (5th cranial nerve which supplies sensation
to the face) as it leaves the brainstem. A vein may
be responsible. Surgery involves moving the artery off
of the nerve, and placing a small ivalon sponge or a piece
of teflon felt between the aftery and the nerve. The
surgeon will close the dura, and may or may not elect
to place a covering over the skull. Possible options
for skull replacement are the patient's own bone, surgical
cement, methylmethacrylate ( a type of hardened plastic),
or titanium mesh. Next the scalp will be closed
for craniotomy for microvascular decompression can be broken
down into two categories, 1) those related to the operative
site, and 2) those related to the risks of anesthesia.
related to the operative site:
Exposure: The patient is placed in a position so as
to allow the surgeon good access to back of the head, behind
the ear. There is risk of non healing of the scalp
post operatively. Although very uncommon, there can
be injury to or tearing of the scalp from the pins on the
Mayfield clamp. There is the potential for spinal fluid
leak postoperatively, which may require additional surgery
injury: The surgery involves opening the back of the
skull behind the ear, and gently retracting the cerebellum
( back of the brain), to expose the fifth cranial nerve
(trigeminal nerve) as it leaves the brainstem. There can
be damage to the cerebellum, brainstem, and cranial nerves
(nerves leaving the brainstem and providing functions such
as hearing, facial movement, and facial sensation).
If there is any damage to the cranial nerves leaving the
brainstem, there may be difficulty with facial sensation
and movement, hearing, eye movement, swallowing, speech,
and tongue movement. If there is brain injury,
this could result in weakness, seizures, stroke, paralysis,
coma or death. There may be residual fluid or blood, requiring
additional surgery in the future. There is a possibility
of facial pain recurring in the future. Facial numbness
may occur. In addition, there could be a painful burning
of the face which occurs in the future (this condition is
known as anesthesia dolorosa).
Risks: These include general difficulties, such
as bleeding, infection, stroke, paralysis, coma and death.
Incisions in the scalp generally heal well, but could become
tender, numb, or may heal in an unpleasant manner. The trigeminal
neuralgia may recur, requiring additional treatment
in the future. In addition, although every attempt
is made to protect all areas of the body from pressure on
nerves, skin and bones, injuries to these areas can occur,
particularly with prolonged cases.
Blood clots in the legs, heart attacks, reaction to the
anesthetic, reaction to blood transfusion, if given.
is surprisingly relatively little pain associated with craniotomies.
Your surgeon will prescribe pain medications for any pain
associated with the incision.
upon discharge, contact our office and set up an appointment
for staple removal if one has not already been made.
it easy until seen by the physician. This does not
mean bed rest, but athletic activities during this period
are definitely not recommended. Please give your
incision a chance to heal. Avoid any type of activity
which might risk a blow to the head.
may resume activity as your body permits, but avoid extremes.
For example, walking is fine, but avoid any strenuous
running. USE GOOD JUDGMENT AND COMMON SENSE.
If you have a question, ask your doctor.
driving until cleared with your surgeon. A driving
test may be required, at the discretion of your surgeon.
Even though you may feel fine, your peripheral vision
and reflexes may have been affected, and we want you to
be safe on the road for yourself as well as for others.
may shower after you go home unless otherwise instructed.
Cover the incision with plastic wrap before the shower
and remove it afterward. Change dressing immediately.
You may shower without covering the incision one week
after the staples are out. Follow instructions concerning
care of tapestrips, stitches or staples. Your surgeon
or nurse clinician will explain the techniques used in
the closure of your incision.
activities are permitted.
you notice swelling, redness or opening of the incision,
or if there is any clear fluid draining from it, please
contact your surgeon immediately! If you develop
a fever, stiff neck or chills, contact the office immediately.
Take your temperature at 4:00 PM daily until the clips
are removed. Call if greater than 101 degrees Fahrenheit.
you have a seizure, notify our office or come to the emergency
you develop any new weakness, notify our office.
If you have any paralysis or weakness, post-operative
care will need to be tailored to this. If a brace
for an arm of a leg has been prescribed, use it as recommended
by your surgeon.
you have any questions, call our office, and for after
hours emergencies, call the medical society.
your medications prescribed on discharge, as directed.
not take any medications which will "thin the blood"
such as coumadin or aspirin, or other non-steroidal antiinflammatory
medications, unless otherwise advised by your physicians.
sure to follow up with any other physicians involved in
your care. These may include your family physician