Microvascular Decompression Surgery for Trigeminal Neuralgia

There can be anaesthesia-related complications. On the surgical side, we can get a haematoma in the cerebellum, sometimes bleeding, sometimes infection, or damage to the nerves — though our infection rate is very low. One patient developed chemical meningitis leading to hydrocephalus and needed a shunt, but the rest did very well. Initially some patients complained of partial hearing loss from traction on the eighth nerve; now we use minimal traction, so results are good and complications are minimal.

Only about 5%, not more than that. In our setup we have done more than 100 surgeries and have not had to redo any; some patients may have mild symptoms that can be managed with medicine or reassurance, but otherwise the results are good.

We do endoscopic third ventriculostomy in paediatric congenital hydrocephalus, but success is slightly lower at a young age — around 70-80%. A programmable shunt has a 95% success rate, but shunt revision and infection are other factors to weigh; endoscopic third ventriculostomy is a better choice when it succeeds, since the chances of recurrence problems afterward are very low.

We keep the patient for three or four days; the pain is usually gone right after surgery. We continue medication for one month afterward and then stop it. We mobilise the patient to walk from the next day, and they generally do very well. We do a post-operative CT scan to check for any bleeding or collection, but results are close to perfect.

The screws used in spine surgery are not absorbable — they remain in place lifelong. Financially, robotic-assisted spine surgery costs about $1,000 to $2,000 extra on top of a normal spine surgery of around $7,000, but the advantage is that screw misplacement drops to less than 1%, which is significant because a single misplaced screw can undermine the whole surgery — so while it adds cost, it also adds real value to the outcome.

Through a small craniotomy, the cerebellum is gently retracted to expose the trigeminal nerve, the compressing vessel, often a vein or artery, is identified touching the nerve, and it is separated with a small patch, usually Teflon or a similar material, placed between the artery and the nerve.

Around 95 percent of patients become pain-free, offering a near-permanent cure.

The procedure costs around 6,000 to 7,000 US dollars, comparable to roughly six months of ongoing medication costs, making surgery a financially reasonable long-term option as well as a clinically effective one.