MVD Surgery

This is my account of Microvascular Decompression of cranial nerves 9 and 10 (glossopharyngeal neuralgia). This neuralgia causes stabbing pain in the throat, typically behind the tonsil (right on target for me). Mine was left side, a particular complication in that the 10th nerve on that particular side also controls heartbeat and rate. Also, given complications with the 8th nerve (hearing) during this type of procedure, the 8th nerve was monitored. I had to go for a "baseline" measure several weeks before the surgery.

The surgery was 7:30 a.m. Monday June 25 and was to be completed by 10:15. As I understand, most of the time is "getting to the spot." The time spent decompressing the nerve is usually less than half an hour (15-20 minutes as my neurosurgeon later explained).

I arrived at the hospital at 6 a.m and began my prep work (donning the highly fashionable attire for the event: tux, shoes, you know...that sort of thing).

At 7:10 they wheeled me into the staging area. This is where all the people going in for operations are lined up, one after the other. I was handled kindly by a resident anesthesiologist who couldn't seem to find a vein in my hand. After much poking, prodding, and otherwise rude behavior with my hand, she finally stuck me in the arm.

At 7:15 the neurosurgeon came in and went over the procedure with me again. This was comforting. About that same time the anesthesiologist came in and introduced himself. He was comforting, too.

At 7:20 they stuck me with something they said would make me go to sleep. And it did. I remember about one more minute.

The first thing I remember about coming out of the surgery was the inability to breathe, like something was in my throat. I tried coughing, but couldn't get a good grip on it.

The next thing I remember is looking at the clock and seeing the time: 2:15. I immediately knew there were complications. I should have finished by 10:30, out of the fog by noon at the latest.

Within a minute or two after that a nurse at my left side asked if I could hear her. I couldn't. The probability that there would be hearing loss was small, but it exists. Someone has to represent that minority! That's me. So far, total hearing loss in my left ear.

Each 24 hours for the next 4 days has it's own description.

The first 24 were just excruciating discomfort. Every 2 hours they would wake me up for vitals, neurology checks (touch your nose, push up with your legs, that sort of thing), drugs, and they had this particularly obnoxious air mask blowing moisturized air at my face. I did almost nothing but sleep until the next day.

The next 24 (Tuesday) were for the most part the same routine, with the exception that I was only awakened every 4 hours and didn't have the jet mask in a rainstorm on my face. By late Tuesday afternoon I was becoming coherent, a little. Still very sore. They actually got me out of bed to walk the halls three times that day. The biggest change was the realization that I couldn't swallow or speak very well. The neurosurgeon explained to me that this was due to the 9th and 10th nerves being stretched and a little swollen from the decompression. He said this should return to normal, but may take awhile (up to six months).

The next 24 hours (Wednesday) things cleared up a good bit, but I was still quite fuzzy from taking medications that I'd normally take with food, plus narcotics for pain, plus pain. This was the day that the neurosurgeon sat down with me (again, clear this time) and explained in more detail what he'd found and why it took longer (he may have explained it earlier, but I was pretty well a zombie before Wednesday). First, he explained that I have an unusually large cerebellum, which made it hard to get into the area he needed to get to (i.e. it took up too much room in the hole). Retracting it also put additional stress on the 8th nerve. At the site, he found an artery crossing the 10th nerve, then the 9th, after which was an arterial branch (the Pica?) which looped back and may have coiled a couple times like a garden hose up against my 9th nerve before crossing the 10th again. This was "the worst case he'd ever seen" and explained that the part of the procedure that would have taken 15-20 minutes took him an hour and 15 minutes. He explained that the 8th nerve gave no warning, but just "dropped" and so he'd suspected that I'd have hearing loss. He believes this will be permanent. So Wednesday was depressing. Can't talk. Can't swallow. Can't hear. The upshot is that my neuralgia seems to be taken care of. Still, depressing. (Kind of asking Lincoln's wife "despite everything else, how did you like the show?")

The next 24 hours (Thursday), things cleared up even more. Eating a little (strained soup, yum!). Had meetings with a speech therapist, which included a video esophagram to watch me swallow. Just as I had described to them, they saw: water going everywhere, particularly up my sinus. The good news was that it was not going into my lungs and that the valve that closes off my lungs seems to be working properly, and the fact that I can feel food/water in there was promising. What is happening is a couple things. My soft palette is nonresponsive, which means it doesn't close off my nasal cavity when food/water reaches back there for a swallow; this doesn't provide my throat with the oomph it needs to force food down my throat, and it provides an alleyway for food to go elsewhere, namely up to my nasal cavity. The other thing that's happening is that side of my throat is a little numb and doesn't function properly, which means even when I get food back there, and am able to force it down a bit, things are a little out of synch and so food doesn't go quite right. This also affects my vocal chords, which is why my voice is "out of tune" at this time.

Discharged at 3:30 Thursday.

The week since then (the rest of Thursday, Friday, Saturday and Today) has been steady improvement. Each day is better, stronger, faster (insert your bionic man sounds here). My voice, while weak, is getting better each day. My swallowing is about the same. I actually ate solid food today (well, a couple pieces of sliced ham...but it counts!). Thursday, Friday, and Saturday I slept close to 14 hours each day. Today (Sunday) I actually spent from 8 a.m. until now awake, with perhaps two hours of "rest" (not sleep, just sitting or lying down quietly). When I'm done with this, I'm done for the day. I can feel that. Perhaps my favorite visitor was my brother Kirk who had similar surgery in 1983 to correct an AVM that complicated his 5th nerve. We compared scars. Same side. Same length. Same diet! We're like old war buddies!

On Tuesday, stitches out, and I begin decreasing my tegratol and neurontin doses. Each week thereafter I decrease them more, and by the end of the month (one month from the surgery date) I will be drug free! And if all goes as planned PAIN FREE!!!

All in all, if my voice returns and my ability to swallow returns, I am satisfied with the trade. I will take deafness in one ear in place of the pain in my throat.