Nerve combing surgery

I had an MRI/MRA done on January 21st at OHSU. They have this amazing software that renders a 3D image of the trigeminal nerve and the surrounding blood vessels. It was very clear that I have no compression on the nerve at all. My doctor recommended a surgery (which I've now completely forgotten the official name of) in which they basically comb the nerve fibers. Apparently does a minimal amount of damage (unlike GK) that shocks the nerve enough to stop the pain signals. I have this surgery scheduled for February 3rd.

As I think about having the procedure I have to weigh lots of issues. Since I've been off work after losing my job due to medication fog, my pain is much less frequent even though I've stopped all TN meds. However, I know that it will come come back, it always does. At 57 years old, it's probably better to get the surgery done now then to wait until I'm older.

I'm pretty frightened about the whole thing. I have my pre-op appointment tomorrow.

Hi, I had my MVD procedure back in August. My MRI (without contrast-allergic) showed no signs of an artery touching the nerve. I knew that something had to be going on in there though because of the pain I was in. I went for the MVD anyway and as it turns out a vein was wrapped around the nerve and the surgery lasted 2 hours longer with a total of 5 Teflon pads. For me it was a quality of life decision that had to be made. I couldn't be on the medications I was on any longer. I wish you the best of luck with whatever surgery you decide on.


my NS has also suggested this for me, for the same reason as yourself, my MRI was inconclusive as it did not show any contact spots. My appointment is on Wednesday, so I wish you the best of luck for tomorrow, I will keep you in my thoughts & prayers.

Dee :-)

Thanks Deanne and Merrra.

As I mentioned, the 3D image was amazing and shows very clearly that there is no compression going on so...nerve combing it is.

Dee...Keep me posted. I'll be thinking of you.

Laura, MRI CANNOT eliminate a nerve compression. On the order of10% or more of all MVD operations discover a previously unseen compression during the exploration phase.

As for "nerve combing", it was a new term for me. The procedure appears to comprise a gentle linear separation of the nerve from surrounding tissues, though I need to do more research to confirm this.

The following abstracts from the US National Library of Medicine appears to be highly pertinent:

"The long-term outcome of nerve combing for trigeminal neuralgia".
Jie H, Xuanchen Z, Deheng L, Kun G, Fengyang X, Xiang C, Xiaoting W, Guangxin Z, Yiqing L.



The purpose of our study was to describe and evaluate the long-term clinical outcome of nerve combing for idiopathic trigeminal neuralgia (TN) with and without vascular compression.


The study included 60 trigeminal neuralgia patients, 28 of which (Group A) had no visible vascular compression intraoperatively and 32 of which (Group B) had trigeminal nerve root entry zone (REZ) compressed by vascular structure. All patients were considered medical failures prior to the surgeries. All of them underwent trigeminal nerve combing. The following outcome measures were assessed: pain relief, recurrence, complication and time to pain relief.


The median duration of follow-up was 52 months (range 48-96 months) in group A and 56 months (range 48-96 months) in group B. Excellent relief and good relief were noted in 23 patients (82.1 %) and two patients (7.1 %) from group A, respectively, and in 20 (62.5 %) and eight patients (25 %) from group B. The major complication of both groups was facial numbness. And the total complication rate was 15.8 % in group A and 18.8 % in group B. Recurrence was found in one patient in group A and in two in group B by the end of follow-up.


Trigeminal nerve combing is effective in treating TN, but has a much higher pain relief rate in patients without vascular compression than those with vascular compression.


Neurol Res. 2013 Mar;35(2):187-92. doi: 10.1179/1743132812Y.0000000132. Epub 2012 Dec 17.

Microvascular decompression treatment for post-Bell's palsy hemifacial spasm.
Li X, Zheng X, Wang X, Li B, Ying T, Li Y, Li S.



This retrospective study is to explore the clinical features and surgical outcomes of the patients who suffered from hemifacial spasm preceded by Bell's palsy.


Seventeen patients with post-Bell's palsy hemifacial spasm underwent microvascular decompression surgery. A 3D-TOF-MRA examination was performed pre-operatively to confirm the existence of offending vessels around the facial nerve. Abnormal muscle response was monitored during operation. The results of spasm resolution and post-operative complications were assessed.


During operation, offending vessels were found and transposed in 15 patients. For the other two patients in whom offending vessel was absent, the facial nerve was treated by combing. The results of spasm resolution were 'cured' in 12 (70·5%) patients, 'improved' in 2 (11·8%) patients, 'fair' in 2 (11·8%) patient, and 'failed' in 1 (5·9%) patient. The complications included transient hearing loss in one case, and deterioration of facial weakness in two cases.


Vascular compression may be an etiological factor of post-Bell's palsy hemifacial spasm, and microvascular decompression is an effective treatment to this disorder.


Regards, Red


As I mentioned, the image I saw was a 3D rendering of an MRI and MRA involved. It was pretty clear that there was no compression. I may end up eating my words after the surgery but at this point I'm sticking with what the doc said.

The procedure is as you described, a separation of the nerve fibers intended to shock the system. I think the doctor used the word combing so that I had a clearer picture of what he was talking about.

Surgery is Monday. I'm very nervous but anxious to have it done.

Good luck! Nerves before surgery are natural, and I think even worse for us because the stakes are so high. I will be very interested in reading everything you have to say about your experience. Here's hoping for a very surgical outcome, and quick and easy healing.

I hope you can bring good news of your own, and hope for others!


best of luck with your surgery, I'll be prayin for a good outcome for you!!

Mine has been postponed, unfortunately, due to a Gastro problem interfering with my body's ability to absorb nutrients etc with no apparent cause, so ns wants to wait til the mystery is solved. Starting to worry I'll never be free of this thing but hopefully you will so take care,



I hope your surgery goes extremely well..and please do come back and post about. We hear lots an lots of the bad....i'm always happy to hear some good!

~Wishing you peace and success


Thank you everyone for your support and well wishes.

I had my pre-op appointment yesterday with blood work and EKG. Everything went smoothly. After that I had a talk with my doctor and asked lots of questions. I even asked him for Valium or something to help with the nerves. He did give me a prescription which I really appreciate.

Now I'm just doing errands to get ready - getting a robe and a pair of slippers that aren't embedded with non-removable dog hair (if you have dogs you know that some fabrics just won't give up the hair no matter how sticky the lint roller), going grocery shopping, making lists and whatnot.

I had this same surgery done at OHSU 3 months ago, and I do not regret it!

Saraiderin, please tell all. Or as much as you care to.

Yes Saraiderin...please would really help those of us considering this option to hear some feedback from someone who has actually gone through it.

Hi Lauren, just stopping in to wish you well with your upcoming surgery! Sending a whack of positive thoughts from Canada!!
(( hugs )), Mimi : )

Hi all,

I had my surgery on Monday and was released yesterday. For those of you unfamiliar with the Portland/OHSU area, the hospital is up on a hill. My bigger worry yesterday was getting off the hill before it started to snow much - Portland pretty much closes down because of snow.

Currently my right side face is completely numb. I know that this is common and will dissipate over the next couple weeks, although it may never go away completely. I had no compression on the nerve at all. Hopefully the nerve combing will disrupt the pain signals. That's the plan at least.

The first 36 hours were really rough. After that it was like a switch flipped and the pain decreased (didn't go away but much less) and the nausea stopped. As I told one of my friends, although I don't feel great under normal circumstances, considering that I had brain surgery 4 days ago I feel very well. I'm keeping up on my pain pills, sleeping a lot and basically just hanging around..

I can write more later if anyone is interested but I'm about ready to go lie back down. I'm taking it very, very easy.

Thank you all for your good thoughts.

Oh yes, there is great interest. But take it easy. So glad to read your pain has lessened. Here's hoping for a quick recovery, with no pain or numbness to plague you anymore.

Hi Laura,

So glad to hear that everything went well & that you are recovering. Thank you so much for taking the time to let us know, we've all been hoping & praying for the very best outcome for you, so you should take things really easy & look after yourself but please do keep us up to date, we really appreciate it.. :-)


Good luck Laura. It is February 8th and am wondering how you are doing?

The procedure is called Internal Neurolysis. It is most commonly done for carpal tunnel syndrome. I had this surgery done at OHSU 3 months ago, and I have no regrets.