The surgery is performed under general anesthesia, through an incision and small thumbprint sized bony opening behind the ear (craniotomy). The surgeon peers into the opening through an operative microscope, looks around the cerebellum (a structure of the brain) and visualizes the trigeminal nerve as it arises from the brain stem (the trigeminal nerve root entry zone).

The aim of MVD surgery is to alleviate neurovascular compression upon the trigeminal nerve root. This permits the trigeminal nerve nucleus to recover from its state of hyperactivity and return to a normal, pain free condition. Micro-instruments are used to mobilise the offending vessels away from the trigeminal nerve root. The decompression is permanently maintained by inert implants, such as those made of shredded Teflon felt, between the offending vessels and nerve.

MVD is a non-destructive technique, and has the best potential for long-term relief or cure of TN pain. However, there is a small risk of complications related to cranial nerve damage including hearing loss and facial numbness. Intra-Operative Monitoring has improved the safety of this procedure. Other risks include the rare incidence of post-operative infection, inflammation or healing difficulty leading to CSF leak. The risk of developing some facial numbness is very small, and the development of deafferentation pain or anesthesia dolorosa is almost unheard of. Other serious complications related to stroke, bleeding, or swelling are exceptionally rare at centres with special expertise in performing MVD surgery.