Jonathan White, M.D.
Department of Neurological Surgery
UT Southwestern Medical Center
5303 Harry Hines Blvd.
4th Floor, Suite 100
Dallas, TX 75390-9167
214-645-2300
www.tiny.cc/jonathanwhite
Transcript: If a microvascular decompression fails, what’s next?
A small portion of patients who under go a microvascular decompression will find that their pain recurs anyway. This usually occurs somewhere around two years after the first microvascular decompression. Fortunately this is rare but the question is “what to do if this arises”. One option would be to do another microvascular decompression. For myself, in general, I don’t think this is the best strategy for recurrent pain. If I’ve done the microvascular decompression myself and the pain has returned, I have a good sense in my mind that the nerve was cleaned off and that compression of the nerve had been relieved particularly if the person had done well for those initial year or two. As a result, I think a better procedure is either the Gamma Knife, a rhizotomy, or a balloon compression.
There are some occasions when a repeat microvascular decompression is appropriate. We’ve had a very small handful of patients who did well for a month or two and then their pain recurred. In those patients, I believe that the blood vessel that was decompressed from the nerve has returned to its original position and that the padding place has slipped and those people I think warrant a reexploration.
Another group of patients that I will sometimes reoperate on is a group of patients who had their microvascular decompression done by another surgeon somewhere else who never got any improvement in their symptoms. And even though the microvascular decompression just may not be destined to work in that patient, I think it warrants a reexploration to make sure that all the blood vessels that were in contact with that nerve have really been moved.