Dr. Matthew Mian

A few days away catching up with old friends and new families!

Beautiful view of cerebellopontine angle anatomy from a microvascular decompression for hemifacial spasm. That’s a juicy basilar artery!

Saturday morning above the tree line.

Is it just me, or does this look like a 🧠?

All smiles on our morning stroll!

When two of your device reps photobomb you at 6AM from another time zone, assuming you’ll find it as funny as they do…

Camping weekend!

Another day, another couple MVDs for trigeminal neuralgia.

This operative view remains one of my favorites in all of neurosurgery. At various times during these procedures, I saw cranial nerves 4 through 10. Some of these are labeled in the images above.

In both cases, I decompressed the trigeminal nerve from a blood vessel. In one case it was an artery. In the other, a vein.

Click more on the link in my bio to learn more about and (MVD).

Sunday morning climb

La Jolla

Outdoor weekend with daddy!

Most cases of are caused by compression of the trigeminal nerve by an artery, but a vein can also be the culprit.

These are images from a patient with trigeminal neuralgia on the right side of her face. She hadn’t found relief with medications or . I offered her a .

In surgery, I found a large vein indenting the trigeminal nerve. I was able to carefully dissect the vein away and insert several small pieces of shredded teflon beneath it. The patient woke up from surgery with resolution of her facial pain.

Click on the link in my bio to learn more about TN and MVD.

Horsin’ around

Afternoon hike!

Warm day at Steamboat!

Steamboat’s a little lumpy today!

A little nippy out here…

Radiosurgery - e.g. Gamma Knife or CyberKnife - is a viable and relatively non-invasive treatment option for many patients with trigeminal neuralgia (TN), but not all patients respond to treatment.

Here’s an example case of a patient treated elsewhere years before with CyberKnife. She had a partial response, but her TN pain came back with a vengeance, and she was more miserable than ever before.

Her MRI (upper right) showed contact of the trigeminal nerve by the superior cerebellar artery. I performed a microvascular decompression (MVD) and was able to dissect this artery free of the nerve (lower image). Note that there is an indented and discolored area on the nerve corresponding to where the artery used to sit (arrowhead).

Patients like this usually enjoy immediate facial pain relief, and studies show that MVD tends to last much longer than radiosurgery.

Both radiosurgery and MVD are important tools for treating TN. If you are struggling with TN, consider seeking out a provider who can offer a balanced discussion of these and other treatment options. The Facial Pain Association is an excellent resource for finding a provider in your area.

Click on the link in my bio to learn more about TN.

While it’s great seeing the mainstream press raising awareness about trigeminal neuralgia, it’s also disappointing that in 2023, this common and very “google-able” disease can be regarded as a “medical mystery” and that a professor in a major city could see numerous specialists over 7 years before receiving a diagnosis and appropriate care.

And yet, I meet patients like this one every week.

Trigeminal neuralgia is (usually) straightforward to diagnose, and in many cases, it can be cured. This article is yet another reminder to advocate for yourself as a patient and to seek out second opinions when something isn’t adding up with your care.

Just horsin’ around

Lively discussion at with thought leaders in the field about the future of for

…and a visit to a bona fide

Another nice example of the benefits of MRI-guided focused ultrasound for tremor. Before and after spiral-drawing, line-drawing, and signatures of a patient I treated recently. I had to obscure the post-treatment signature because it’s actually legible!

Click on the link in my bio to learn more about focused ultrasound thalamotomy for tremor.

This little guy.

Microvascular decompression (MVD) can be a great salvage option for patients who have failed previous treatment for trigeminal neuralgia.

These are images from one my MVDs this week. This is a patient who previously underwent Gamma Knife and only enjoyed partial relief of his facial pain. Note the artery loop (left image) that was indenting the surface of the trigeminal nerve. This dissection was tricky due to the presence of multiple tiny perforating vessels coming off the main artery. I carefully dissected the artery free and placed tiny pieces of shredded teflon beneath it to buttress it away from the nerve (right image). Facial pain relief is generally immediate.

Click on the link in my bio to learn more about surgery for TN.

Will you be at AES in ?

Join me Sunday evening for a discussion about developments in surgery for epilepsy! We’ll focus in particular on workflows for RNS in patients with temporal lobe epilepsy without intracranial monitoring.

Register at: NeuroPace.com/RNSDinner

Hope to see you there!

Nap time over. Surgery’s done.

Cancer from elsewhere in the body can cause symptoms when it spreads (metastasizes) to the spine. Spine metastases are common, and they can cause rapidly progressive neurologic deficits.

These are images from a patient with recently diagnosed liver cancer who suddenly developed numbness from the chest down and weakness in his legs that prevented him from standing or walking. An MRI showed an aggressive tumor (yellow arrows) compressing his spinal cord (green arrow).

I performed urgent surgery to remove the tumor and stabilize the vertebrae that had been eaten away by the tumor. His sensation began to improve immediately, and he’s already standing again and taking a few steps!

Click on the link in my bio to learn more about the treatment of spinal tumors.

Evening walk

Friday ride around Manitou and Colorado Springs.