Robert A. Mericle, M.D.
Department of Neurological Surgery
Vanderbilt University Medical Center
B-1053 Preston Research Bldg.
Nashville, TN 37232-5345
615-322-7417
http://www.mc.vanderbilt.edu/surgery/neurosrg/Staff/Mericle/mericlebio.htm
Transcript: Microvascular decompression surgery explained
A microvascular decompression in my practice at Vanderbilt University, we will go in for patients who have trigeminal neuralgia, sharp stabbing pain. We make an incision behind the ear, it’s usually very small, a couple of centimeters. And we take a very small piece of bone off and when we’re done we put the bone back. A lot of doctors will leave it off but in our practice, we always put it back and fasten it with these titanium clamps. My Mom taught me to always put things back the way I found them. So. Now, you know, it makes people feel better having that back in there I think.
And then we go in, it’s not very far, go down a little bit and find the trigeminal nerve. And that’s where it’s real important that you have a lot of experience that the surgeon doing it has a lot of experience because you need to look all the way around the trigeminal nerve. And if this is the trigeminal nerve here and if there’s a blood vessel pushing on it, sometimes it’s easy and you can see it and its obvious right there. You can put a pad there. What most people do is take the blood vessel off and put a pillow between the two. What I tend to do in my practice is I’ll put, I will do that but I’ll also extend the pillow all the way around the nerve, that way if the blood vessel slips over the top of the pillow, it can’t hit it from the top of the nerve or if it slips over the bottom, it can’t do that. And sometimes there’s more than one blood vessel. There could be a vein or an artery pushing on the nerve from some other region. And if you pad the nerve all the way around, I think you’re most likely to be able to get the best microvascular decompression result to stop the pain and hopefully will last hopefully the rest of your life.