Jeffrey A. Brown, M.D.
Neurological Surgery, P.C.
600 Northern Blvd., Suite 118
Great Neck, NY 11021
516-478-0008
http://www.neurosurgeryli.com/dr.brown.html
Transcript: If a microvascular decompression fails, what’s next?
Important question. I think my most recent understanding is what I’ve learned because in my office in New York, I have a MRI machine right across from my office and I can supervise a technician doing that MRI designed specifically to show us the trigeminal nerve and any evidence for a vascular association that we might see. And if we can’t see it, I can repeat the study till I can see it.
What I’ve learned, and it’s very important, is that if the pain recurs after a microvascular decompression, and I mean recurs meaning it did fine and then the pain comes back, my finding and I think Dr. Jannetta’s is that there’s an artery or a vein that’s been missed. Smaller maybe then the one that caused the original problem but it’s coming into being now and if you do a very careful MRI, you can see that. And if you can see that vessel then you can feel confident in saying “We need to go back and do another microvascular decompression. It worked once. It will work again if done for the right reasons.”
Now there may be situations where it’s too difficult to do that. It may be years down the line. There may be medical problems that prevent you from doing that microvascular decompression. Okay. So what do you do now? Well that’s when you have to sit down and say “What’s the safest thing to do?” Sometimes patients are now on blood thinners. Many patients are on blood thinners as they age now and this may move you towards something that’s least invasive. We haven’t talked that much about CyberKnife® that might be an option or Gamma Knife or balloon compression. Percutaneous operations though they seem safer may not be safer. Everything has a risk and there isn’t any perfectly safe operation. So you have to sit down and go through the medical condition and go through the analysis. It takes time and you need to spend that time.