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When is it too soon to consider microvascular decompression?

Dr. Geoffrey P. Colby, MD
Neurosurgery
I think it's important first to go through a trial of medication, certainly with Tegretol, possibly with Lyrica or Dilantin, to really see if you can get control. In certain cases, trigeminal neuralgia will be bad for a few months and then taper off, and it may not come back for a year or two.

I recommend being a bit conservative, but if the pain is severe and has lasted for four, five, or six months without much success with medications, then that certainly is not too soon to consider a microvascular decompression operation. On the plus side, if you are younger, you are much more tolerant of anesthesia and surgery. One recovers more quickly. It's not as stressful, and the risks are lower, so I don't recommend waiting years and years if you have typical trigeminal neuralgia. If the medication is not providing adequate relief, the surgery probably will.

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