A positive MVD surgery experience and outcome

Please allow me to present an overview of my MVD surgery. It was a positive experience. Understandably this Forum has more negative experiences documented overall than positive ones. I understand the nature of this and certainly have compassion for those who MVD is not possible or did not work out as expected. My hope here is to give optimism to those awaiting MVD or deciding to proceed with it.

On the afternoon of July 17, 2012 I had MVD surgery at The Massachusetts General Hospital (MGH) in Boston, Massachusetts, USA. The surgery was performed by Dr.Emad Eskandar, the Director of Stereotactic & Functional Neurosurgery and the Director of the Neurosurgery Residency Program at MGH, also Associate Professor@ Harvard Medical School. He was assisted by a team of Drs including specialists from The Massachusetts Eye and Ear Institute to monitor my hearing during the surgery. The surgery was successful in eliminating my TN pain.

I had been on Tegretol and Neurontin since my TN diagnosis in April of 2011. Whenver the pain increased so did my dosage of carbamazepine and so did my mental "fogginess". This became intolerable in late 2011 and I looked for another option. MVD seemed the likely choice for me.

I decided I needed advanced care from somewhere with frequent TN contact and experience. This led me to MGH. Their credentials are outstanding ( easily looked up). I met with a neurologist there and we added a medication ( Indocin) that eliminated the hemi-cranial headaches I was experiencing and tinkered with my carbamazepine dosage. During this time (early 2012) I had a thin slice FIESTA MRI of my brain, head and neck performed. No gross abnormalities according to the report but some compression around the right trigeminal nerve.

Prior to meeting for the first time with the Neurologist at MGH I was investigating who could/would perform MVD for me. My research led me to Dr.Eskandar at MGH. Experienced (wasn't sure how experienced yet,) credentialed and associated with one of the worlds finest hospitals and medical schools.

I attempted to make an appointment but his office suggested I proceed with the neurological team at MGH and if needed they would refer me to him. Good. They eventually ( April 2012) did refer me. I had an appointment for May 8.

I met with Dr Eskandar ( Dr.E) on May 8th and he showed me the MRI. He described and pointed out how my left trigeminal nerve was clear ( no compression) and how my right was not , he felt that there was a significant compression there. I could see the difference plainly. He felt I was an excellent candidate for MVD. 90% success rate and less that 1% complication rate. I asked how many MVD's he had performed (hundreds) and how often (50/100 annually.) This was very acceptable to me. Studies have shown that how often the Dr and facility perform MVD has a positive correlation to success rates.

July 17 came and I went to MGH. Everything was very smooth. Check in, preparation, etc and I was sent to preop. The Drs and nurses all came in, said hi, explained and double checked ( actually i was asked 5 times) what they were going to be doing .

An IV line was inserted. I was taken to a new (8/2011) operating room and was quickly asleep. I awoke 3 hours later in a dedicated neurological intensive care unit. I was very thirsty but otherwise OK I was monitored very closely for the entire night and half the next day when I was moved to a regular room for 1 more night and left on the morning of July 19.

I was given mild pain killers after the operation for mild discomfort, emphasize mild. I felt better than expected. A little sore from the operation but nowhere near TN pain and I havent had ANY TN pain since.

Saw the Dr the following morning after being visited several times by the neurolgical residency team, some of whom assisted in the surgery. I had a very large compression of the nerve caused by a cerebellar artery. It was in two places. It was moved and buffered so it was not in contact with the nerve. Classic MVD surgery.

I have a 5-6 inch incision that was sutured with dissolvable sutures and this was covered with a dissolvable protectant which has since dissolved. The sutures are almost gone.

This past week I went for my follow up visit with Dr. Eskandar and was cleared to resume normal activities.

I still have a bit of a numb tongue and chin from the manipulation of the nerve which should subside ( already has) ina few weeks.

If you have any questions about my experience PLEASE contact me. I am very happy to share my experience. It has been nothing but positive. Just to be able to wash my face and brush my teeth without any pain has been worth it, let alone the other triggers.

Please consider this life changing surgery as a solution for TN. When it is successful it FIXES the problem. It doesn't mask it as medicines do. It has worked for me. While there are no guarantees going forward I expect that this will be a lifetime fix.

Best,

Rick ( Coventry, RI, USA)

Rick, I am so happy and pleased to read this, how wonderful for you. And as you say a great note of positivity.

Dear Rick:

I am happy to hear a success story. My neurologist is not adverse to me doing gamma knife or MVD if another drug regime does not stop the pain and does not make me loopy/unbalanced. I do not have pain constantly, and I keep I wondering if I am a wuss, but I am so tired of worrying whether brushing my teeth, blowing my nose, laughing, even talking will set off the pain.

Did you consider gamma knife, and what type of MRI is the FIESTA? I had a fancy pants high resolution one done a while ago for a cholesterol granuloma in my temporal bone and need to find out at my next appointment in 3 weeks if it showed compression of the trigeminal nerve. My neurosurgeon is dying to have me as a patient again, guess my brain is fascinating!

I figure if I can be discharged 48 hours after having my brain cracked open, my vertebrae shaved, my cerebellum pruned and my skull patched with fascia from my thigh for a Chiari malformation, this will be a piece of cake! My neurologist and neurosurgeon both say if you believe there will be success, there will be as that is half the battle. What did he tell you about long term success rates?

Interestedly yours,

Mollycule

i been thinking about having a mvd surg. thanks for the info,from my research it looks like mvd has the least bad feedback

Welcome to the club! It's grand aint it?

BUT -- week 11 I had to go back on meds for 2 months - now all better.

Don't be alarmed and remember it takes up to a full year for nerves to heal.

Thanks for posting!

What marvelous news! I am so happy for you and it gives such hope to anyone else who may be contemplating MVD. Thanks so much for taking the time to let us hear how things went.

Great hope! I’m scheduled with the Mayo clinic later this month, which I’m assuming will result in mvd. I’m excited! How much tegritol and neurontin were you on prior to surgery?



Hello I read your reply to Rick and see that you , like me, have had decompression surgery due to a Chiari Malformation. I would love to compare notes with you if you are willing. I just sent you a friend request, so hope to hear from you. Thanks Christine mollycule said:

Dear Rick:

I am happy to hear a success story. My neurologist is not adverse to me doing gamma knife or MVD if another drug regime does not stop the pain and does not make me loopy/unbalanced. I do not have pain constantly, and I keep I wondering if I am a wuss, but I am so tired of worrying whether brushing my teeth, blowing my nose, laughing, even talking will set off the pain.

Did you consider gamma knife, and what type of MRI is the FIESTA? I had a fancy pants high resolution one done a while ago for a cholesterol granuloma in my temporal bone and need to find out at my next appointment in 3 weeks if it showed compression of the trigeminal nerve. My neurosurgeon is dying to have me as a patient again, guess my brain is fascinating!

I figure if I can be discharged 48 hours after having my brain cracked open, my vertebrae shaved, my cerebellum pruned and my skull patched with fascia from my thigh for a Chiari malformation, this will be a piece of cake! My neurologist and neurosurgeon both say if you believe there will be success, there will be as that is half the battle. What did he tell you about long term success rates?

Interestedly yours,

Mollycule

Thanks for the good wishes all .

To the questions.

Mollycule: I researched and spoke with another surgeon who specializes in Gamma Knife surgery. For me the potential negative outcomes,potential side effects and nerve degradation outweighed the positives. Especially vs MVD. The odds did not favor GK for me.

FIESTA( fast imaging employing steady rate aquisition) is the General Electric trade name (acronym) for a newer type of high resolution MRI which is capable of producing higher resolution images, very useful in detecting trigeminal nerve compressions. Siemens and Phillips also make similar MRI units which have their own trade names.

Long term success rate better than 90 %

mcschub: I was at 1200mg daily of Tegretol at the height. 700 MG at time of the operation. I took neurontin for a short time as I had very negative side effects at a pretty low dosage, sorry I dont recall the exact amount as I write this.

Currently I am at 300mg daily of Tegretol and 10 mg baclofen. These will be discontinued totally as I "step down" within the next 2-3 weeks

Also, as you probably know, The Mayo clinic is very well regarded inthe area of Neurosurgery. I wish you the best of luck!

I just read your informative positive experience. I really appreciate your taking the time to do that. I am going for an evaluation @ Johns Hopkins on Mon., Aug. 13. Up until 2 years ago, I have been a very active, healthy 68 yr. old woman.

Thanks for your story.

Dixie: You and all are very welcome. I want to help answer as many questions for as many people as I can. Thank you for your kind words.

I wish you the best of luck in your upcoming evaluation. I would recommend you write down all your questions ( if you havent already) to make the most of your visit.

Johns Hopkins, as I am sure you know, is a leader in TN evaluations, MVD surgery and medicine in general.If I had not gone to MGH I would've gone to Johns Hopkins, without question. You'll be in good hands.

Write me personally if I can help.

Rick

Hi Rick,
Thanks so much for sharing your positive experience. I am considering MVD, and was glad to hear you have had such a good outcome.
Best wishes for continued pain free days!
Christine

Thanks Rick! My neuro has said if he cannot 'control' the pain level - just increased the Trilep to 900mg daily with up to 500 mg Teg inbetween as needed - he wants to refer me to a neurosurgeon. ...not what I am wanting to hear; I fool myself into thinking I am not in THAT much pain, but I know if I were to be off of the meds I couldn't tolerate it... What you said about the side effects of the meds is just BLAHHHK!

You have given me a renewed hope in that the surgery MIGHT me something I consider at some point in time. I appreciate you willingness to share your experiences!!

So happy to hear of your outcome, Rick! I too had a successful MVD on June 3oth. I suffered for 4 yrs with the severe shocking pain under my teeth. I would encourage anyone who is otherwise healthy and a candidate for surgery to strongly consider it. I know it is a personal decision, and also very scary. However, the hope for a cure swayed me in the direction of surgery. I am happy to say that I have not had TN pain since I awoke from anesthesia. There is hope for this disease!!

thank you so much for sharing.

was your situation a typical TN ?(with the sharp pain zaps etc ? ).

did you pain started after a dental procedure ? was is constant pain ?

i was offered an MVD (was shown a blood pressuring my nerve). but since i have atypical TN , and it started after a dental procedure - the problem. logically , is local - so an MVD wouldn't solve it :(

don't know what to do

Hi ,

I did have typical TN pain, zings, I called em . Zaps is sure accurate too. After a few months the TN zaps started initiating, burning ,crushing, stabbing pain in my forehead. The worst.

Fortunately, I was never in 24/7 pain. My heart goes out to those in constant pain.

My pain showed up in April of 2011. No obvious trauma started it. I thought I had a sinus infection at first but that was quickly ruled out and TN was ruled in.

My advice is to do your research and follow your instinct.

Nir Morita said:

thank you so much for sharing.

was your situation a typical TN ?(with the sharp pain zaps etc ? ).

did you pain started after a dental procedure ? was is constant pain ?

i was offered an MVD (was shown a blood pressuring my nerve). but since i have atypical TN , and it started after a dental procedure - the problem. logically , is local - so an MVD wouldn't solve it :(

don't know what to do

CONGRATS!!! I couldn't be happier for you. "As you say.... "the hope for a cure swayed me in the direction of surgery" . Me too, thats it right there. Thanks for sharing

blder1 said:

So happy to hear of your outcome, Rick! I too had a successful MVD on June 3oth. I suffered for 4 yrs with the severe shocking pain under my teeth. I would encourage anyone who is otherwise healthy and a candidate for surgery to strongly consider it. I know it is a personal decision, and also very scary. However, the hope for a cure swayed me in the direction of surgery. I am happy to say that I have not had TN pain since I awoke from anesthesia. There is hope for this disease!!

RickRI - thanks for the replay.

i think your case was a classic case for MVD (mine isn't. altho i AM showing somekind of blood vessel pressuring the nerve) - so you were 'fortonate' in that.

thanks for the reply.

Nir, just wanted to tell you for what it's worth, my pain also started spontaneously after a dental cleaning. About 4 days later to be exact. For the four years I had it, mostly I had the shocking TN1 pain. There were also times I had constant pain under my teeth and jaw when I was in really bad flareups. If you have been told you have a compression visible, I would not rule out MVD giving you relief. My pain was all dental and "logically" it should have been treated locally. I went from doctor to doctor trying to find a cause and they could find nothing. Finally, a neurosurgeon thought he saw the compression on my nerve. The doctor who actually did my surgury says many such compressions do not even show up on MRI. He found two on my nerve when he opened my head. I have not felt pain in my teeth since I woke up from surgery. Do not rule out MVD if you have a competent surgeon who thinks this may help you. It could be the cure you are searching for. Just my two cents. Best of luck!

blder1 -

thank you so much for the information. it's so improtant.

i feel almost at the bottom. i take cymbalta . it helps - but it's still not good.

how are you today - are u pain free ? (i'm afraid to ask since you still 'hang out' in this forum).

thank you so much you encouraged me.