Microvascular decompression of the cranial nerves (Janetta)

What is microvascular decompression?

Microvascular decompression (Janette surgery) is surgery to relieve abnormal compression of the cranial nerve that causes trigeminal neuralgia, glossopharyngeal neuralgia, or hemifacial spasm.

Janette's operation involves opening the skull (craniotomy) and inserting a sponge between the nerve and the damaging artery to trigger pain signals. Microvascular decompression is an option when medications become ineffective or cause side effects. This sponge insulates the nerve from the pulsation and pressure of the blood vessel.

MVD is a surgical procedure to relieve symptoms (pain, muscle twitching) caused by compression of a nerve by an artery or vein.

How is microvascular decompression performed?

Surgery involves opening the skull (craniotomy) and exposing the nerve at the base of the brainstem to insert a tiny sponge between the pressure vessel and the nerve.

When is the operation performed?

The patient is shown an operation if there is:

• trigeminal neuralgia, which is poorly controlled by drugs;
• facial pain is isolated in the ophthalmic section or all three sections of the trigeminal nerve;
• relapse of facial pain after previous surgery.

What happens during surgery?

The operation is performed under general anesthesia and usually takes 2-3 hours.

The procedure involves creating a small (2.5 cm diameter) bony window in the skull - craniotomy - just behind the ear. The surgeon opens the membrane covering the brain ("dura mater") and then, using an operating microscope, identifies the trigeminal nerve, which connects to the brainstem. When a blood vessel puts pressure on a nerve, it is carefully detached from the nerve, and a small piece of a special Teflon sponge is inserted between them to prevent further compression of the nerve. After that, the bone flap is fixed with titanium plates, which are screwed in. Sometimes bone cement is applied to the opening of the skull. Then the overlying muscles and skin of the skull are returned to their place and sutured.

What happens after the surgery?

The patient is transferred to the intensive care unit for close observation during the night by our specialists. When the condition stabilizes, he will be transferred to a regular room, where he will increase the level of activity (sitting in a chair, walking). After 1-2 days, the patient will be discharged from the clinic, and our doctors will give recommendations for further care.

What are the results of Janette's surgery?

The operation is very successful in treating trigeminal neuralgia (95% efficiency) with a low risk of pain relapse (20% over 10-20 years).

What is the cost of microvascular decompression?

The price of microvascular decompression at the Dobrobut MS in Kyiv will depend on many factors: on the severity of symptoms, the method of execution, and whether the cost includes materials that are used as a spacer between the structures of the GM.

You can make an appointment for a consultation and operation with our specialists at the Dobrobut Medical Center in Kyiv by leaving a request on our website, or by calling the call center number.

Bibliography

1. Taha JM, Tew JM Jr: Comparison of surgical treatments for trigeminal neuralgia: Reevaluation of radiofrequency rhizotomy. Neurosurgery 38:865-871, 1996.
2. McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK: Microvascular decompression of cranial nerves: Lessons learned after 4400 operations. J Neurosurgery 90:1–8, 1999.
3. Trigeminal Neuralgia FAQ. Published online, 2021.