Microvascular Surgery :Treatment, Procedure, Cost And Side Effects

The Microvascular surgery is operated on very small blood vessels that are as small as of three to five millimetres in diameter. It is an immensely complex as well as important surgery that requires specialised tools that are of ultrafine structure including fine and tiny needles and much more. The treatment includes two different methods of surgery namely the Microvascular reconstructive surgery and the Microvascular Decompression surgery. The Microvascular reconstructive surgery is done in order to reconstruct different parts of the body of the patient using their own tissues that are damaged due to cancer or other diseases using a high-magnification microscope. Two of the known Microvascular reconstruction surgery is for the Head and the neck reconstruction where the blood vessels, bones and tissues as well as the muscle and skin are used to rebuild the face and the neck parts of the body. The other surgery is the Microvascular Decompression surgery that treats the abnormal compression of the cranial nerve causing trigeminal neuralgia, glossopharyngeal neuralgia and hemi facial spasm. It is done by opening out the skull and then inserting a sponge in between the nerve and the offending artery that triggers the pain signals. Initial medication provides initial relief however; in the end, the surgery has to be done for a better treatment since the drugs can become ineffective in a larger span of time when the problem progresses and can also lead to many side effects at the same time.

The Microvascular reconstruction surgery or treatment is done by transferring the isolated tissue of a body part on the arteries and veins known as the free flap where the tissue is composed of fats, skin, muscles and even bones or combination of these to reconstruct another body part. For the successful transfer of the tissue a microscope with magnifying power up to 50 times to that of naked eye is used and stiches are done that are ultra-fine i.e. finer than a single hair. Thus, the surgeons are able to reconnect the tiny blood vessel on the side of free flap to the receiving blood vessel subsequent to the part of the body that is affected by cancer. The microscope of such a high magnifying power is used because the blood vessels are pretty small that is about 1 to 3 mm in diameter and thus to avoid any error, blood clotting and any other risk as well as ensure accuracy and precision in working.

On the other hand, the Microvascular decompression surgery involves the procedure of craniotomy or the opening out of the skull and revealing the nerve at the base of brainstems to place a sponge between the nerve and the compressed vessel thus separating the nerve from the pulsation going on with the vessel and thus protects the nerve from its pressure. To treat the trigeminal neuralgia, the sponge in inserted between the trigeminal nerve and the superior cerebellar artery. Thus with the procedure the compression that was leading to the painful symptoms are removed and so it is known as Microvascular decompression surgery.

The Microvascular decompression surgery is ideal to be done for a person whose trigeminal neuralgia is not controlled by medications and the person prefers very minute to no numbness of the face that is present in other types of treatments. It also for people having facial pain in the ophthalmic division as well as the reoccurrence of the facial pain after a radiosurgery or percutaneous procedure. On the other hand, the Microvascular reconstruction surgery is applicable for those people who are or were affected by cancer in one of the body parts that destroyed the structure of it and thus they take up the surgery to reconstruct those parts. It is also applicable for traumatic defects, congenital defects, compromised wounds etc.

For the Microvascular decompression surgery, since it involves the use of general anaesthesia as well as brain surgery in the procedure so people with other medical conditions or with poor health cannot be treated. In addition, it is not ideal to treat facial pain that happens due to multiple sclerosis. In addition, it has some risk of hearing loss so people with hearing problem in other ear or one of the ears are not eligible for the procedure.

On the other hand, for the Microvascular reconstruction surgery, people who with connective tissue disorders, vasculitis, peripheral vascular disease, severe obesity and any other disorder or disease that might affect adversely the coagulation and healing part of patients.

For the side effects concerning the Microvascular decompression surgery, there are chances of reaction to anaesthesia, strokes, seizures, venous sinus occlusion, swelling of brain or CSF leak. There are also other side effects like hearing loss, double vision, facial paralysis or dysphagia and many other such disorders or side effects.

For the side effects concerning the Microvascular reconstruction surgery includes, difficulty swallowing on the receiving site for the neck reconstruction surgery as well as difficulty in breathing and many other such problems. In case any patient reports any other complexity after undergoing the treatment the patient is advised to consult the doctor immediately.

The post-treatment guidelines for the Microvascular decompression surgery involves close observations over the patient while in the intensive care unit, also some amount of nausea and headache is expected so medications can control these symptoms and restrictions on long periods of sitting and driving is also advised. With the stability in the health and condition, the patient is taken to regular room followed by 1 to 2 days after discharge along with discharge instructions specifying the dos and don’ts that the patient has to keep in mind. The anti-convulsants for trigeminal neuralgia taken by the patient before the surgery will be slowly weaned off the medications as per a schedule to decline the risks of withdrawal and side effects and other problems.

The post-treatment guidelines for the Microvascular reconstruction surgery includes creating of an “anastomosogram” that depicts the position of all the blood vessels and which of the vessels were used. Then, the on call resident is called to check the flaps overnight for every 3 hours that will go on for the next 24 hours’ time post-operation. This is followed by the evaluation of the flaps by the nursing staff every hour for first 48 hours using the assessment of Doppler signal and colour. Then later it is evaluated after every 4 to 5 hours for next four to five days. The patients head position is to be specified, in general midline with no pillows. In addition, various post-operation anti-coagulation aids are also in practise.

The treatment recovery time varies from the patient condition to condition and differs from the mode of the treatment opted for the patient. After the Microvascular Decompression surgery, it takes 1 to 2 days of observation period in the hospital after which the patient is discharged with discharge instructions. The patient can shampoo and shower in 3 to 4 days after surgery in normal situations and the staples and sutures will be removed in 7 to 14 days post-surgery. Gradually the patient can return to normal day structure.

For the Microvascular reconstruction surgery, a hospital stay of about 7 days and a full treatment time for about 15 days is required.

For the Microvascular reconstructive surgery the cost of treatment in India is for about INR 5 LAKHS in the Artemis hospital in Gurugram, Haryana. It is around INR 5.5 LAKHS in Apollo hospital, Mumbai. On the other hand, the Microvascular decompression surgery costs to about since the branch of medicine is highly specialised as per different types of cases so the cost is not determined prior to encountering the case. However, a general cost of the particular treatment is about INR 4 LAKHS.

The Microvascular decompression surgery is a highly specialised treatment that in safe hands is highly affective with low risks and side effects applied and has a success rate of 80-90%, however, it does have a recurrence rate of about 50% at 1 year.

For the Microvascular reconstruction surgery, a stable aesthetic outcome is incurred in 1 years’ time after the procedure.

1. The alternatives for the Microvascular decompression surgery are the Gamma knife radiosurgery treatment, percutaneous Rhizotomy, and pain stimulator placement.
2. The alternative for the Microvascular reconstruction surgery includes Spiral CT Angiography that is an alternative for head and neck reconstruction surgery.