====== Microvascular decompression (MVD) ======

{{ ::microvascular_decompression.jpg?300|}}

[[3D-BRAVO]] combined with 3D-[[TOF]] sequence reconstruction before microvascular [[decompression]] can fully evaluate the morphology, location, and anatomical relationship of lesions, which is of guidance value for clinical diagnosis and treatment
((Li J, Wang Y, Lian Z, Liu R, Liang Z, Song C, Song Q, Wei Z. The Value of
Three-Dimensional Brain Volume Combined with Time-of-Flight MRA in Microvascular 
Decompression. Stereotact Funct Neurosurg. 2019 Jul 9:1-7. doi:
10.1159/000500995. [Epub ahead of print] PubMed PMID: 31288239.
)).

[[Microvascular decompression]] (MVD) for neurovascular compression syndromes, such as [[trigeminal neuralgia]] and [[hemifacial spasm]], has been traditionally described as an interposing technique using [[Teflon]]. Some alternative interposing materials have been proposed. In addition, [[transposing]] techniques have been increasingly reported as an alternative with a potentially lower recurrence rate and fewer complications.
((Gonzalez-Quarante LH, Ruiz-Juretschke F, Agarwal V, Garcia-Leal R.
Microvascular Decompression for Trigeminal Neuralgia Using a Novel Fenestrated
Clip and Tentorial Flap Technique. World Neurosurg. 2017 Oct;106:775-784. doi:
10.1016/j.wneu.2017.07.110. Epub 2017 Jul 25. PubMed PMID: 28754638.
)).

===== Indications =====

see [[Microvascular decompression for hemifacial spasm]]

see [[Microvascular decompression for trigeminal neuralgia]]

see [[Microvascular decompression for glossopharyngeal neuralgia]].

Combined [[Hyperactive dysfunction syndrome]] (HDS) involves a group of functional disturbance disorders affecting specific [[cranial nerve]]s, and may include TN, HFS, and GPN. In addition to [[gender]] and [[hypertension]] incidence, [[age]] appeared to be a vital parameter for developing combined HDS, although this finding was inconsistent in previous studies. [[MVD]] appears to be a safe and effective treatment for combined HDS, with a high rate of long-term success
((Zhang YQ, Yu F, Zhao ZY, Men XZ. Combined hyperactive dysfunction syndrome of 
the cranial nerves: analysis of 37 cases and literature review. World Neurosurg. 
2019 May 31. pii: S1878-8750(19)31514-1. doi: 10.1016/j.wneu.2019.05.237. [Epub
ahead of print] PubMed PMID: 31158546.
)).

===== Training =====

In a [[retrospective]] [[analysis]] of [[patient]]s who have undergone [[Microvascular decompression]] by the trainee (07/2014-07/2017) and by the [[senior]] neurosurgeon (03/2011-04/2015). Data such as surgery time, [[length of stay]], [[outcome]]s and [[complication]]s were collected.

Out of the 18 cases of MVD were performed by the trainee, 10 were supervisor trainer un[[scrub]]bed (STU) or performed (P) and 8 were supervisor trainer scrubbed (STS). Mean surgical [[time]] was 2:30 hrs and mean length of stay was 6.33 days. The mean outcome score was 2.33/3 with 89% cases a positive outcome. The complication rate was 16.7%, of which one had meningitis, one had CSF leak and one developed a pseudomeningocele. The trainee's surgery time, outcomes and complication rates were comparable to trainer and the literature. There was a statistically significant correlation between number MVD performed and operative time (R = -0.50, p < .05), intervals between MVDs and complication rates (R = 0.64, p < .05), and interval between MVDs and outcome scores (R = -0.66, p < .05). Phang et al., estimate the time between cases should be below 40 days.

[[Training]] a trainee is safe and does not add much [[burden]] to the hospital. A trainee will benefit the most if they have the same supervisor at least for the first eight cases and that each case should be done within 40 days of each other
((Phang SY, Martin J, Zilani G. Assessing the safety and learning curve of a
neurosurgical trainee in performing a microvascular decompression (MVD). Br J
Neurosurg. 2019 May 21:1-4. doi: 10.1080/02688697.2019.1617401. [Epub ahead of
print] PubMed PMID: 31111746.)).

===== Complications =====

[[Microvascular decompression complications]].

===== Case series =====

see [[Microvascular decompression case series]].

===== Case reports =====

2 patients with bilateral transient dilated and fixed pupils after MVD and discussed the possible etiologies through the literature review. Physical examination of both patients showed bilateral pupils were normal and without a medical history of pupil dilation. They underwent MVD under general anesthesia and used propofol and sevoflurane. In both cases, the vertebral artery was displaced, and Teflon pads were inserted between the vertebral artery and the brain stem. Postoperation, we found transient bilateral mydriasis without light reflection in both patients. The emergency head computed tomography revealed no obvious signs of hemorrhage and cerebral herniation. About 1 hour later, this phenomenon disappeared. Therefore, the authors think if MVD is successfully carried out, bilateral transient mydriasis may not necessarily indicate brain stem hemorrhage, cerebral herniation, and other emergency conditions, which can be recovered within a short time. The causes could be related to stimulation of the sympathetic pathway in the brain stem during MVD and side effects of anesthetics
((Wang L, Fan H, Xu X, Su S, Feng W, Wu C, Chen Y. Bilateral Transient Dilated and Fixed Pupils After Microvascular Decompression: Rare Clinical Experience. J Craniofac Surg. 2023 Mar 21. doi: 10.1097/SCS.0000000000009293. Epub ahead of print. PMID: 36941233.))
===== References =====