What it is
Microvascular decompression (MVD) is performed through a small opening behind the ear — a retrosigmoid craniotomy roughly the size of a quarter. Using a surgical microscope, the surgeon identifies the point where the trigeminal nerve enters the brainstem and separates the offending blood vessel (almost always an artery) from the nerve. A small cushion of Teflon felt is placed between them to prevent re-contact.
Unlike percutaneous procedures or radiosurgery — which work by injuring the nerve to reduce signaling — MVD addresses the root cause without deliberately damaging the nerve itself. This is why it offers the highest long-term pain relief rates and the best preservation of normal facial sensation.
Why it's considered the gold standard
For medically fit patients with typical trigeminal neuralgia who have failed medication, MVD has the best durability of any available treatment. Long-term pain relief rates exceed 70–80% at ten years in most series. Facial numbness — a predictable side effect of ablative procedures — is avoided.
The trade-off is that it is a real craniotomy with general anesthesia, a one- to two-night hospital stay, and a recovery of one to two weeks. For younger or medically fit patients who want lasting relief rather than repeated procedures, it is often the right choice.
Alternatives
For patients who prefer a less invasive approach, have significant medical comorbidities, or have atypical features, percutaneous procedures (balloon compression, glycerol rhizotomy) or stereotactic radiosurgery are appropriate alternatives. The discussion includes expected durability, side effect profiles, and what the options look like if pain recurs.