Microvascular Decompression (MVD) of the 8th Nerve

Discussion in 'Treatments' started by rtwombly, Apr 23, 2014.

    1. rtwombly

      rtwombly Member

      Southeast USA
      Tinnitus Since:
      Cause of Tinnitus:
      Hiya! Been lurking for awhile. After three months of aggressively seeking treatment for my tinnitus, I am currently undergoing some therapy that will take time to show results. Meanwhile I've been reading about microvascular decompression of the 8th nerve and the success some patients have had in relieving their symptoms after this surgery. Some cases are discussed here: https://www.tinnitustalk.com/thread...-cures-some-peoples-tinnitus.1792/#post-15300. From what I've read, the "controversial" nature of applying MVD to tinnitus is that some studies have shown non-symptomatic patients with similar vascular compression to symptomatic patients. In fact, vascular compression has appeared in the asymptomatic ears of patients affected unilaterally.

      Some years ago I did some reading about male pattern baldness. Basically, some men go bald due to a genetically predisposed sensitivity to a by-product of testosterone. Men who don't go bald may not have that predisposition, or they may have insufficient levels of testosterone to produce the by-product in toxic amounts. Thus, it's a combination of genetic and other factors that create the condition.

      Could something similar be responsible for tinnitus in individuals with vascular compression of the 8th nerve? Could the compression be the basic cause, but depend on a genetic-or-environmental predisposition to produce its symptoms? That would explain why some people with vascular compression are asymptomatic. The genetic argument is harder to make regarding asymptomatic ears of unilateral sufferers; however, this does not rule out environmental factors. For that matter, might there not be a genetic difference between the two ears?

      I hope someone is pursuing this avenue of medical research. I've recently been reviewing the results of my MRI (it's not a tuumah) and am impressed by the amount of data that can be gleaned from this technology. Unfortunately, I have no idea how to spot abnormalities myself. The consulting neurologist gave me a clean bill of cranial health, but we didn't speak in person. I have no way of knowing if vascular compression is a diagnosis s/he would have considered, and I am weighing up the pros and cons of seeking a second opinion.

      Anybody know of ongoing MVD-VIII research? Any advice on getting a neurootologist to walk me through my MRI?
    2. No I don't know of any research but I do know a TN sufferer who had hyperacusis( many do actually along with t) not sure about t and while she had her mvd they also fixed the 8th nerve and her h was MUCH BETTER afterwards. Anyways I suspect it be hard to find a surgeon perform this for just t. It is brain surgery after all.
    3. daedalus

      daedalus Member

      Tinnitus Since:
    4. David S

      David S Member Benefactor

      Tinnitus Since:
      Hope to get some more interest in this thread. For all of us with unknown cause of T a nerve compression might be the problem, might also be in combination with cochlear damage. Dose anybody knew whats characteristic for a nerve caused T? I've heard that if you have tics around your eyes in combination with T that could be an indicator. Also that it doesn't have to be synchronized with your pulse.

      Here is a quite recent report of a surgical approach to solve the problem. It seams to be quite promising.


      Also here is a very recent studies how to better determinate if you might benefit for a operation.


      Did any of you T fellows consider this route?
    5. martin12

      martin12 Member

      Tinnitus Since:
      I'm wondering if a blood vessel could compress the 8th nerve due to head trauma? Thanks.
      • Good Question Good Question x 1
    6. skoupidis

      skoupidis Member

      Tinnitus Since:
      Cause of Tinnitus:
      Acoustic trauma or mvc
      What kind of doctor is capable of performing this operation? (MVD)
      My MRI show I have in vascular compression on the 7th and 8th nerve of the right ear. This is where my tinnitus comes from, although I thought it was due to acoustic trauma. I also have hyperacusis.

      My ENT gave me Neurontin (Gabapentin) for this condition, but I read there is a 3 years window for Microvascular Decompression operation. Actually they say the sooner the better. Perhaps the damage to the nerve becomes irreparable after some time of vascular compression.
    7. maz1

      maz1 Member

      Tinnitus Since:
      Cause of Tinnitus:
      who knows
      Im going to bump this old thread.
      I think that micro vascular compression is a topic not well enough explored.
      I'd like to hear from any member that has had an mvd either for a neuralgia or T, H.

      I have been having bizzare and excruciating ear, face pain T and H over the past year. Diagnosed, misdiagnosed, doctors that just threw their hands up and say that they havn't a clue try a cocktail of anticonvulsants and hope for relief..
      I had a my 4th mri in a year's time, this time ordered by a neurosurgeon who suspected mvc.
      An MR with the 'fiesta' sequence is need calling special attn to the cranial nerves. A normal MR will not visualize the nerves nor any attached small blood vessals.
      Sure enough my MR report showed a few compressions on the 7th, '7-8 complex' (nerve bundle to the ear) and a suspect compression on the glossopharyngeal nerve.
      All findings were unilateral located on the side with all if the pains.
      Findings have been confirmed by 6 neuologists and surgeons from NY, Pittsburg, to Ca.

      I did want to revive this discussion as it could shed light for some members suffering with ear and facial pain. I had to go to lengths, and visited some very prodominent ent's and I have to add, do not care or pethaps do not understand basic ear innervation. I know that is a neuro's job, but ent's do not wish to even explore that realm in the most basic context which is a bit of a diservice to many as the ear is jam packed with nerves. (4 cn's to be exact?). I cannot help to add that the effort that i received from ents (approx 10) was pitiful. Likely the reason why the understanding of T and H remains in the dark ages. It took a cross boundry approach lead by neurology to address my ear issues.

      I'm sharing my information in hopes to find others that have explored this territory or might have something to add.

    8. ReyKalinic

      ReyKalinic Member

      Tinnitus Since:
      Cause of Tinnitus:
      Triggered by TN
      You have the lucky to have the opinions of the biggest neurosurgial school about nerve compression (moller & jannetta in pittsburgh) and ask for an opinion on internet? sorry i'm confused. Here there aren't surgeons. I have trigeminal nevralgia and tinnitus due to vascular compression. i deal using anticonvulsant oxcarbazepine and clonazepam with some effects even on tinnitus. Surgery will be my last chance for a lot of reason. Follow your prescription. Don't trust internet opinion. Good Luck
    9. maz1

      maz1 Member

      Tinnitus Since:
      Cause of Tinnitus:
      who knows
      I certainly appreciate your input, especially from a fellow TN sufferer. You obviously know the pain.

      I have been told that MVD would be my next best (only) move however have been given lousy odds on MVD success due to the my 'complex and atypical symptoms'.
      The reason for my inquiry to the 'internet' is to survey other's experiences and other possibilities. I am not soliciting for information on where or who should I go to. Neurosurgeons aren't Otologists, and diagnosis of a nerve compression is a clinical one, there is grey area. You have to agree that information gathering is a major responsibility while contemplating brain surgery.

      I would like to know more about your symptoms and the location of your compression. Do you have typical, atypical, Geniculate, GPN? I'd like to hear about your symptoms in detail if you cared to share? Please contact me via PM if you are more comfortable. I would greatly appreciate it.
    10. ReyKalinic

      ReyKalinic Member

      Tinnitus Since:
      Cause of Tinnitus:
      Triggered by TN

      the administrators of this site are afraid of my sincerity and not allow me to send private messages on my part. I am a person "uncomfortable."

      Back to us; My first symptoms was the pain in the face, like electric shocks intermittant. It happened after a trivial but violent basketball rebound on my left cheekbone. In the previous days i had a dental surgery.
      The pain initially was intermittant. Not costant but one night (it still happen if i don't use the full medications dosages) it was starting to be excruciating and with a mild tinnitus that was triggered by the pain (now is costant). So i went to the er and after to a private clinic in Marseille for an mri.
      The diagnosys was of nerovascular compression of the 7 and 8 nerve but... the most important question is; is possible that a basketball in face is able to trasnform the nerve and vessel position? Maybe they were already in those position. and in fact... read here; "
      Our findings showed that anterior inferior cerebellar artery (AICA) loops in CPA (type I) were found to be present in 65% of patients with tinnitus (44/68), in 72% of controls (62/86), and in 83% of patients (35/42) in the group formed by asymptomatic sides of patients with unilateral tinnitus (Table 2). AICA loops lying in the IAC but not extending >50% of its depth (type II) were detected in 26% of patients with tinnitus (18/68), in 17% of controls (15/86), and in 7% of patients (3/42) in the group formed by asymptomatic sides of patients with unilateral tinnitus (Table 2). AICA loops extending >50% of the length of IAC (type III) were found to be present in 9% of patients with tinnitus (6/68), in 11% of controls (9/86), and in 10% of patients (4/42) in the group formed by asymptomatic sides of patients with unilateral tinnitus (Table 2). However, these results did not show a statistically significant difference for the presence of all types of vascular loops (P > .05).

      Vascular contact with the eighth CN was depicted in 53% of patients with tinnitus (36/68), in 41% of controls (35/86), and in 40% of patients (17/42) in the group formed by asymptomatic sides of patients with unilateral tinnitus. The angulation of the eighth CN was found to be present in 15% of patients with tinnitus (10/68), in 13% of controls (11/86), and in 14% of patients (6/42) in the group formed by asymptomatic sides of patients with unilateral tinnitus. Again, there was no statistically significant difference between the groups for vascular contact and the angulation of the eighth CN (P> .05)"

      Vascular or not.... is difficult! http://www.ajnr.org/content/29/9/1746.full

      image1.jpg image2.jpg

      Maybe our mri are similar. On the right you can see the left side with a clear cut crossover conflict between 7 and 8 nerve (facial and cochlear) with artery AICA inside....but....

      we have an huge problem; for trigeminal nevralgia, the decompression (as soon is possible) guarantee a good relief but it can come back in the future.

      For tinnitus, not. With high risk of bias and worsening. Even with others diagnostics tool like ABR, Nistagmography, and simptoms expecially the motion intolerance.

      Forgive me if i say; american doctor are too much aggressive. But it 's real. They do too "easy" on surgery. I hope that if you have a diagnosys of vascular conflict, Your neurologists will try all the medications available before go for surgery. You have a window of time; 4 years. You could spend this time tryng anticonvulsant like tegretol or trileptal and doing this you coul take double results. Therapeutic and diagnostics. If the medication work, the diagnosys is confirmed. Another possible exam is the stellate ganglion blocking. If it work, the diagnosys is confirmed. Now i'm curious about what the surgeons have suggested for you. I hope not surgery. Expecially if your tinnitus is not pulsatile.

      I invite you to read with attention this document that end; as the previous article quote;
      Findings of this study showed that the presence of a vascular loop either in contact with the eighth CN and causing angulation of the cisternal component of the nerve or its penetration into the IAC does not correlate with reports of unexplained tinnitus by the patient. Therefore, we think that the diagnosis of the eighth CN vascular compression syndrome should not be based solely on imaging findings, and this recommendation may prevent considering unnecessary surgery.


      Take care.

      hold on
      • Helpful Helpful x 1

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