Specialist neurosurgery · United Kingdom
Microvascular decompression in the UK, by a consultant skull-base neurosurgeon.
The gold-standard, durable operation for classical trigeminal neuralgia and hemifacial spasm - performed at a UK specialist neurosurgical centre, with a neurology, neurosurgery and pain MDT reviewing your MRI before you commit.
Why patients choose us
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A consultant neurosurgeon, in a specialist centre
Microvascular decompression is not a general-neurosurgery case. We route you to a UK skull-base surgeon who does this operation week in, week out.
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MDT before you commit
Neurology, neurosurgery and pain read your MRI together. If a less invasive route is right for you, we say so - honestly.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What microvascular decompression costs privately in the UK.
Indicative ranges at UK specialist neurosurgical centres. Insured cases are almost always covered - self-pay all-in fees are what we quote below.
In short
Self-pay MVD in the UK: £22,000–£35,000 all-in, home in 2–4 days.
| Procedure | Indicative range | Typical duration | Recovery / turnaround |
|---|---|---|---|
| Neurosurgical consultation | £300–£500 | 45–60 min | Report in 3–5 days |
| MRI trigeminal (FIESTA/CISS + MRA) | £600–£1,100 | 40–60 min | Report in 2–5 days |
| Microvascular decompression (self-pay) | £22,000–£35,000 | 3–4 hr op | 2–4 nights inpatient |
| MVD via UK PMI (Bupa, AXA, Vitality) | Covered - subject to policy | 3–4 hr op | 2–4 nights inpatient |
| Gamma Knife SRS (alternative) | £12,000–£18,000 | Half-day | Effect over weeks |
| Percutaneous rhizotomy (RF / glycerol / balloon) | £6,000–£10,000 | 60–90 min | Same day / overnight |
Prices vary by centre, by surgeon and by inpatient length of stay. MVD is funded on the NHS at recognised specialist centres, and covered by most UK insurers when clinically indicated. We quote a firm figure within one working day.
The problem
The right operation, in the right hands, at the right time.
Classical trigeminal neuralgia and hemifacial spasm are misdiagnosed for years, then treated with the wrong operation by the wrong specialist. The choice between MVD, a percutaneous rhizotomy and Gamma Knife is not a coin toss - it turns on your age, MRI and general health.
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Not sure it is really TN?
A dedicated MRI and a neurologist’s eye rule out MS, tumour and atypical facial pain before any surgeon opens the skull.
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Medication no longer working?
When carbamazepine or oxcarbazepine stops controlling the pain or the side effects become intolerable, MVD is the most durable next step.
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Fit for surgery, want it once?
For patients under 65 in good health, MVD offers the longest pain-free interval of any intervention we have.
The journey
From enquiry to recovery - what happens, in order.
One team from first message to your post-operative MRI - including the MDT that decides whether MVD is right for you at all.
Phase 1 · Before your operation
MRI, MDT and consultation
Phase 2 · Admission and surgery
2–4 nights inpatient
Phase 3 · After
Recovery and MRI follow-up
- 01
Before
You tell us what is going on
A short, confidential form. The pattern of the pain or spasm, what medication you have tried, and any imaging already done.
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Before
MRI and MDT review
A dedicated MRI with FIESTA/CISS and MRA sequences - the study that shows a vessel touching the nerve at the brainstem. Reviewed at MDT.
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Before
Neurosurgical consultation
You meet the consultant neurosurgeon. Options - MVD, medication, percutaneous procedure or Gamma Knife - are laid out with the numbers, not a script.
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Admission
Admission and anaesthetic
Admission the morning of surgery or the night before. General anaesthetic, lateral position, careful monitoring of the facial and hearing nerves.
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Admission
The operation itself
A small retrosigmoid craniotomy behind the ear. Under the microscope the offending vessel is lifted off the nerve and cushioned with Teflon felt. 3–4 hours.
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Admission
HDU overnight
A night on HDU or ITU for close observation, then to the neurosurgical ward.
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After
Recovery and follow-up
Discharge at 2–4 days, back to office work in 2–4 weeks, driving 4–6 weeks, no heavy lifting for 6–8 weeks. MRI follow-up is arranged.
Typical end-to-end: 4–8 weeks from enquiry to surgery. Full recovery: 6–8 weeks.
When it helps
When microvascular decompression is the right operation.
The classical indications, plus the one red flag on MRI or examination that means MVD is not the next step.
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Classical trigeminal neuralgia
Sudden, electric-shock facial pain in the distribution of the trigeminal nerve - the commonest reason for MVD.
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Hemifacial spasm
Involuntary twitching or contraction of one side of the face - vascular compression at the facial nerve root entry zone.
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Glossopharyngeal neuralgia
Rare - sharp pain in the throat, tonsil, ear or back of the tongue triggered by swallowing.
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Geniculate neuralgia
Very rare - deep, stabbing ear pain from vascular compression of the nervus intermedius.
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Failed or intolerant of medication
Carbamazepine, oxcarbazepine, lamotrigine, gabapentin or baclofen no longer controlling the pain, or side effects have become intolerable.
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MRI-confirmed vascular contact
High-resolution MRI showing a loop of artery - usually the superior cerebellar artery - touching the nerve at its brainstem entry point.
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Younger patient, long life expectancy
MVD is the most durable treatment for TN - often the right first-line surgery for patients under 65 with good general health.
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Red flag: sensory or motor deficit
Facial numbness, weakness or a suspicion of MS or a tumour on MRI is not classical TN - a different workup, not MVD as first step.
Alternatives to MVD
MVD is not the only route through this.
Every reasonable option on the table - from medication and Botox to ablative procedures and Gamma Knife - with the trade-offs stated plainly.
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Microvascular decompression (MVD)
Retrosigmoid craniotomy behind the ear. The offending vessel is lifted off the nerve and cushioned with Teflon felt. Non-destructive - the nerve is preserved.
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Radiofrequency thermocoagulation
Percutaneous partial rhizotomy through the foramen ovale. Ablative - quick, less invasive, but more sensory deficit and shorter durability.
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Glycerol rhizolysis
Percutaneous injection of glycerol into Meckel’s cave. Less painful than RF but relief is often less durable.
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Balloon compression rhizotomy
A small balloon is inflated against the ganglion under X-ray. Useful in elderly or medically frail patients.
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Gamma Knife stereotactic radiosurgery
A focused dose of radiation to the trigeminal root. No incision. Effect builds over weeks to months, and remains an option later in life.
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Medical therapy (first line)
Carbamazepine, oxcarbazepine, lamotrigine, gabapentin, pregabalin or baclofen. Response to carbamazepine is often diagnostic in classical TN.
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Botulinum toxin (hemifacial spasm)
Injections every 3–4 months. Effective but temporary - MVD is the definitive alternative for the right patient.
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Consultation only
An honest MDT view on whether MVD, a percutaneous procedure or radiosurgery best fits your age, general health and imaging.
Our vetted UK network
A small panel of skull-base neurosurgeons, we picked them.
Consultant skull-base neurosurgeons at recognised UK specialist centres in London, Cambridge, Oxford and the North. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every neurosurgeon in our network.
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Consultant skull-base neurosurgeons at recognised UK specialist centres
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MDT review with neurology, neurosurgery and pain before every case
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Intra-operative facial and cochlear nerve monitoring as standard
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Full alternative pathway on offer - MVD, percutaneous rhizotomy and Gamma Knife
Safety and outcomes
What to expect afterwards - honestly.
MVD is a major neurosurgical operation with a strong safety profile in high-volume UK hands. Immediate pain relief is achieved in 85–95% of patients, and 70–80% remain pain-free at 10 years - the best long-term result of any treatment for classical TN.
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Facial numbness
Some numbness in the treated side of the face is common (10–30%) and usually mild and temporary. Persistent numbness at one year is 5–10%.
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Hearing loss
The hearing nerve runs close to the surgical field. Sensorineural hearing loss or tinnitus affects 5–10% of patients; audiometry is done before and after.
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Facial weakness
Temporary facial weakness is uncommon and usually recovers. Permanent weakness is rare in high-volume hands.
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CSF leak
Cerebrospinal fluid leak occurs in 2–5% - treated with bed-rest, a lumbar drain or, occasionally, surgical repair.
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Meningitis
Rare - chemical (aseptic) meningitis is commoner than bacterial. Managed on the neurosurgical ward.
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Stroke or cerebellar injury
Rare - from cerebellar retraction or a vascular event. Minimised by experienced hands and careful microsurgical technique.
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Recurrence of pain
5–25% of patients experience some return of pain over 10 years. Repeat MVD, a percutaneous procedure or Gamma Knife are all options if this happens.
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DVT, PE and wound infection
Standard neurosurgical risks - mitigated with prophylactic stockings, LMWH and antibiotic prophylaxis.
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Mortality
Very rare - under 1% in high-volume UK specialist centres. Age, comorbidity and the specific vessel involved all matter.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever vessel the surgeon finds, the note that comes back to you keeps to the same shape.
A quiet reminder
Neurosurgical language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the operation note before your review, just ask.
- 01 Header
Indication and MRI findings
The diagnosis - classical TN, hemifacial spasm, glossopharyngeal neuralgia - and the offending vessel identified on pre-operative MRI.
- 02 Technique
Craniotomy and microscopic findings
Side operated, size and position of the retrosigmoid craniotomy, the vessel found compressing the nerve at operation, and the material used to cushion the nerve.
- 03 Findings
Nerve monitoring and immediate result
Intra-operative facial and cochlear nerve monitoring readings, and - for hemifacial spasm - the abnormal muscle response before and after decompression.
- 04 Impression
Recovery plan, driving, MRI follow-up
Read this first: expected inpatient stay, when it is safe to drive and lift, and when your post-operative MRI is scheduled.
Recognised by major UK insurers
Microvascular decompression is covered by most UK insurers when clinically indicated, with pre-authorisation. We confirm cover, excess and hospital tier before booking.
Frequently asked
Everything we get asked about microvascular decompression.
Quick answers on outcomes, alternatives, recovery, cost and the honest question - will the pain come back.
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What is microvascular decompression (MVD)?
MVD, sometimes called the Janetta procedure, is a neurosurgical operation to relieve trigeminal neuralgia, hemifacial spasm or glossopharyngeal neuralgia. Through a small opening behind the ear, the surgeon lifts a blood vessel off the affected cranial nerve at the brainstem and cushions the gap with a small piece of Teflon felt - the nerve itself is preserved.
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How well does MVD work for trigeminal neuralgia?
It is the most durable treatment we have. Around 85–95% of patients wake up pain-free, and about 70–80% remain pain-free without medication at 10 years. No other treatment for classical TN matches those long-term numbers.
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How is MVD different from Gamma Knife or a percutaneous rhizotomy?
MVD treats the cause - the vessel touching the nerve - and preserves the nerve. Gamma Knife, radiofrequency, glycerol and balloon procedures deliberately damage the nerve to stop pain signals. They are less invasive but less durable, and they leave more numbness. MVD is generally preferred for fitter patients under 65; ablative options suit older or more comorbid patients.
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How long is the operation and hospital stay?
The operation takes 3–4 hours under general anaesthetic. You will spend one night on HDU or ITU and go home on day 2–4 in most cases.
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What does MVD cost privately in the UK?
Self-pay ranges from about £22,000 to £35,000 all-in - surgeon, anaesthetist, theatre, HDU night and inpatient stay. Most UK insurers cover MVD when it is clinically indicated; we confirm cover before booking.
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How long is recovery - when can I drive and go back to work?
Most people are back to office work within 2–4 weeks, driving after 4–6 weeks and heavy lifting after 6–8. Wound tenderness and mild fatigue can linger a couple of months. If you have a history of seizures the DVLA must be told.
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What are the main risks?
Facial numbness (usually mild, sometimes permanent), hearing loss (5–10%), CSF leak (2–5%), meningitis (rare), stroke or cerebellar injury (rare), recurrence of pain over years (5–25%), and - very rarely - death. Risk is lowest in high-volume UK specialist centres.
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Will the pain come back?
For most people, no. About 5–25% see some recurrence over 10 years. If pain returns, a repeat MVD, a percutaneous procedure or Gamma Knife can all be considered - the door is not closed.
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