Microvascular decompression (MVD) is a neurosurgical procedure designed to address a very specific problem: long-term irritation of a cranial nerve by a nearby blood vessel.
In daily clinical practice, we often see patients whose symptoms are not caused by damage to the nerve itself, but by constant pulsation of an artery or vein pressing against it. Over time, this contact can disrupt normal nerve function and lead to severe pain, involuntary muscle contractions, or other persistent neurological symptoms.
The key principle of MVD is simple, but technically demanding.
The procedure does not aim to destroy or weaken the nerve. Instead, it focuses on removing the source of irritation by gently separating the vessel from the nerve and preventing further contact.
For many patients, MVD is discussed only after conservative treatments have failed or stopped providing meaningful relief. It is not a shortcut and not a routine recommendation — it is a targeted solution for carefully selected cases.
Conditions where MVD is used
Microvascular decompression is not a universal neurosurgical procedure. Its use is limited to specific conditions where vascular compression plays a central role.
In clinical practice, MVD is most commonly considered in:
- Trigeminal neuralgia, when imaging and symptoms suggest nerve compression and medical therapy is no longer effective or tolerated
- Hemifacial spasm, particularly in cases with progressive or persistent involuntary facial muscle contractions
- Glossopharyngeal neuralgia, a rare but severe pain condition linked to irritation of the glossopharyngeal nerve
- Selected cases of cranial nerve–related neuropathic pain, when other causes have been excluded
It is important to emphasize that the presence of a vessel near a nerve on MRI alone is not enough. Many people have vascular contact without symptoms. The decision to consider MVD is based on the combination of clinical presentation, symptom pattern, response to prior treatments, and imaging findings.
Technical aspects: what patients usually want to know
When discussing microvascular decompression, most patients focus less on the surgical theory and more on practical questions. These usually come up early in the consultation.
Anesthesia
MVD is performed under general anesthesia. Patients are fully asleep throughout the procedure, and careful anesthetic monitoring is essential, particularly in older patients or those with additional medical conditions.
Duration of surgery
The length of surgery can vary depending on anatomy and the specific nerve involved. In most cases, the procedure takes several hours. The emphasis is not on speed, but on precision and safety.
Preparation before surgery
Preoperative preparation typically includes detailed imaging, neurological evaluation, and standard medical clearance. Patients are advised about medications that may need to be adjusted beforehand, as well as practical planning for the hospital stay and early recovery period.
Hospital stay
After surgery, patients are usually monitored in the hospital for several days. This allows for observation of neurological function, pain control, and early recovery. The exact duration of hospitalization depends on individual progress rather than a fixed timeline.
Recovery and rehabilitation
Recovery after microvascular decompression is usually gradual and varies from patient to patient. There is no fixed timeline that fits everyone, and this is something we explain early on.
In the first days after surgery, the focus is on basic recovery: pain control, balance, neurological stability, and overall well-being. Some patients notice improvement in symptoms relatively quickly, while for others changes occur more slowly over weeks or months.
Fatigue is common in the early phase. This does not necessarily indicate a complication — it is often part of the normal healing process after neurosurgery. Patients are usually advised to limit physical strain initially and return to daily activities step by step.
Formal rehabilitation is not always required. In many cases, recovery is guided by gradual return to normal routines, attention to sleep, and avoidance of unnecessary stress. When needed, supportive therapies may be recommended based on individual symptoms rather than as a standard protocol.
Follow-up evaluations play an important role. They allow assessment of symptom progression, identification of temporary postoperative effects, and reassurance during the recovery period.
Who may be a candidate for microvascular decompression
Not every patient with facial pain or nerve-related symptoms is a candidate for microvascular decompression. Careful selection is one of the most important factors influencing outcomes.
In general, candidates for MVD are patients whose symptoms are strongly suggestive of nerve irritation caused by vascular compression, and who have not achieved sufficient relief with conservative treatments.
We usually consider several elements together:
- the nature and pattern of symptoms
- response to medications or other non-surgical therapies
- imaging findings that support a vascular–nerve relationship
- overall health status and surgical risk
Age alone is not an absolute limiting factor. More important considerations are general medical condition and the ability to tolerate anesthesia and recovery.
Equally important is understanding patient expectations. MVD is not offered as a guaranteed solution, but as a carefully considered option when the potential benefits outweigh the risks.
In some cases, after thorough evaluation, the conclusion may be that surgery is not the right step — and that decision is just as valid as proceeding with treatment.
If you are considering microvascular decompression or want to understand whether this procedure may be relevant in your case, a structured consultation can help clarify the options.
During the consultation, we focus on the clinical picture, prior treatments, imaging findings, and realistic expectations — not on rushing decisions.
To schedule a consultation:
📞 Phone: +972-73-374-6844
📧 Email: [email protected]
💬 WhatsApp: +972-52-337-3108
Sometimes a single, well-structured conversation brings more clarity than weeks of searching online.
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Professor Ido Strauss
Neurosurgery
Experienced Neurosurgeon ,Director of Functional Neurosurgery and Stereotactic Radiosurgery
Keinan Ori
Neurosurgery
Head of the service of surgical treatment of diseases and injuries of the spine of the hospital
Professor Yonatan Roth
Neurosurgery
Head of the Neurosurgery Department at Ichilov Medical Center (Tel Aviv) , Chief of Pediatric Neurosurgery at Dana-Dwek Children’s Hospital
Rachel Grossman
Neurosurgery
Brain Tumor Removal Specialist, Deputy Head of the Department of Neurosurgery
Professor Shlomo Konstantini
Neurosurgery
Head of the Department of Pediatric Neurosurgery at the Pediatric Center
Zvi Ram
Neurosurgery
Neurosurgery
Frequently Asked Questions (FAQ)
Can symptoms disappear immediately after MVD?
Yes, this can happen — but it is not something we promise or expect in every case.
In some patients, improvement is noticeable shortly after surgery. In others, symptoms fade more slowly as the nerve recovers. Both scenarios are considered normal.
Is microvascular decompression considered a major surgery?
From our perspective as a neurosurgical team, yes — this is a major procedure.
It involves work around delicate cranial nerves and blood vessels, which requires experience and careful planning. That said, “major” does not mean “unsafe” by default. With proper patient selection and modern surgical techniques, the procedure is usually well controlled.
How do patients usually feel right after surgery?
The first days after MVD can be quite different from one patient to another.
Some feel relief from their main symptoms early on, while others mainly notice fatigue, headache, or balance issues at first. These early postoperative sensations are common and usually improve gradually.
What happens if MVD does not bring full relief?
This is an important question, and one we discuss openly before surgery.
If symptoms persist or partially return, we reassess the situation. Sometimes additional non-surgical treatments are helpful. In other cases, the conclusion is that surgery has reduced — but not completely eliminated — nerve irritation.
Is age a limiting factor for microvascular decompression?
Age alone is usually not the deciding factor.
What matters more is overall health, neurological status, and the ability to tolerate anesthesia and recovery. We see patients of different ages, and decisions are always individualized.
How long before patients can return to normal activities?
There is no single timeline that fits everyone.
Some patients resume light daily activities within a few weeks, while others need more time. We usually recommend a gradual return to routine rather than rushing recovery.
Why is imaging not enough to decide on surgery?
Because anatomy alone does not explain symptoms.
Many people have vascular contact with cranial nerves and never develop pain or spasms. Surgery is considered only when imaging findings match the clinical picture and symptom pattern.
What is the most important thing patients should understand before choosing MVD?
That this is a decision, not a reflex.
Microvascular decompression can be highly effective in selected cases, but it is never offered as a “one-size-fits-all” solution. A thorough consultation is essential to understand whether the potential benefit justifies the risks.
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