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
Transcript: Who is a good microvascular decompression candidate?
When I’m teaching the residents and they ask me “Who the best candidate is for a microvascular decompression?” I tell them there are several important features that predict who will do well with a microvascular decompression and the more of these features you have, the more likely the operation will be successful and the more you deviate from that pattern, the less likely you’ll get cured with your microvascular decompression.
The most important thing about that to me is the character of the pain that you have. The pain should be on one side of the face. The pain is typically described as an electric like shock pain. The pain is intermittent with periods that you’re pain-free between these shock-like episodes. You should be able to trigger the pain by brushing your teeth, a gust of wind, touching your face somewhere. And a fifth criteria for me is that you’ve gotten some response somewhere from one of the medications. Tegretol has helped your pain some. Lyrica. Something has done something to make the pain a little bit better. Maybe you had trouble taking it. Maybe you couldn’t stay on the medicine but something has made your pain better at least temporarily.
Now, not everybody who gets the microvascular decompression has every one of these features. But if you have every one of those features, you probably have a 90-95% chance of initially having success with your microvascular decompression.
There’s another type of pain that may occur after you’ve had your trigeminal neuralgia for a long time. And in those people there’s a constant pain in addition to their electric like shock, intermittent pain. And Dr. Burchiel calls that “Type 2” trigeminal neuralgia. And these people can still get better with the microvascular decompression but you may not do as quite as well as those people who don’t have the constant pain.
Another question in deciding whether somebody should get a microvascular decompression is your general health. In general, you should be healthy, able to walk around the block, have your medical problems well controlled on medication. People who have unstable heart problems or have a lot of pulmonary difficulties would probably do better with a different procedure.
Another question people ask me is about age. Is there some age at which you should not get a microvascular decompression. Some people have said age 65 may be the cut-off for that and I think that’s probably way too low. And most of the people who need a microvascular decompression are considerably older than that.
I think if you’re healthy and have your medical problems under control, you can safely have a microvascular decompression into your eighties and maybe even beyond. But it’s a very individualized thing and the older you are, the more care should be taken to make sure your general healthy for surgery.