Microvascular decompression for trigeminal neuralgia in elderly patients

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  • Jannetta Center for Cranial Nerve Disorders, Department of Neurosurgery, Allegheny, General Hospital, Allegheny Neuroscience Institute/Drexel University College of Medicine, Pittsburgh, Pennsylvania
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Object

Although microvascular decompression (MVD) for patients with medically refractory trigeminal neuralgia (TN) is widely accepted as the treatment of choice, other “second-tier” treatments are frequently offered to elderly patients due to concerns regarding fitness for surgery. The authors sought to determine the safety and effectiveness of MVD for TN in patients older than 75 years of age.

Methods

The authors performed a retrospective review of medical records and conducted follow-up telephone interviews with the patients. The outcome data from 25 MVD operations for TN performed in 25 patients with a mean age of 79.4 years (range 75–88 years) were compared with those of a control group of 25 younger patients with a mean age of 42.3 years (range 17–50 years) who underwent MVDs during the same 30-month period from July 2000 to December 2003.

Results

Initial pain relief was achieved in 96% of the patients in both groups (p = 1.0). There were no operative deaths in either group. After an average follow-up period of 44 and 52 months, 78 and 72% of patients in the elderly and control groups, respectively, remained pain free without medication (p = 0.74).

Conclusions

Microvascular decompression is an effective treatment for elderly patients with TN. The authors' experience suggests that the rate of complications and death after MVD for TN in elderly patients is no different from the rate in younger patients.

Abbreviations used in this paper: CSF = cerebrospinal fluid; LOS = length of stay; MVD = microvascular decompression; SRS = stereotactic radiosurgery; TN = trigeminal neuralgia.

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Contributor Notes

Address correspondence to: Raymond F. Sekula Jr., M.D., Jannetta Center for Cranial Nerve Disorders, Department of Neurosurgery, Allegheny General Hospital, 420 East North Avenue, Suite 302, Pittsburgh, Pennsylvania 15212. email: rsekula@wpahs.org.
  • 1

    Amador N, , Gorman DA, & Pollock BE: Results of repeat posterior fossa exploration for patients with medically intractable trigeminal neuralgia. Neurosurgery 59:471, 2006

    • Search Google Scholar
    • Export Citation
  • 2

    Ashkan K, & Marsh H: Microvascular decompression for trigeminal neuralgia in the elderly: a review of the safety and efficacy. Neurosurgery 55:840850, 2004

    • Search Google Scholar
    • Export Citation
  • 3

    Barker FG II, , Jannetta PJ, , Bissonette DJ, , Larkins MV, & Jho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:10771083, 1996

    • Search Google Scholar
    • Export Citation
  • 4

    Dripps RD: New classification of physical status. Anesthesiology 24:111, 1963

  • 5

    Hasegawa T, , Kondziolka D, , Spiro R, , Flickinger JC, & Lunsford LD: Repeat radiosurgery for refractory trigeminal neuralgia. Neurosurgery 50:494502, 2002

    • Search Google Scholar
    • Export Citation
  • 6

    He W, , Sengupta M, , Velkoff VA, & DeBarros KA: 65+ in the United States: 2005. Current Population Reports Washington, DC, US Government Printing Office, 2005

    • Search Google Scholar
    • Export Citation
  • 7

    Jannetta PJ, , McLaughlin MR, & Casey KF: Technique of microvascular decompression. Technical note. Neurosurg Focus 18:5 E5, 2005

  • 8

    Javadpour M, , Eldridge PR, , Varma TR, , Miles JB, & Nurmikko TJ: Microvascular decompression for trigeminal neuralgia in patients over 70 years of age. Neurology 60:520, 2003

    • Search Google Scholar
    • Export Citation
  • 9

    Katusic S, , Beard CM, , Bergstralh E, & Kurland LT: Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945–1984. Ann Neurol 27:8995, 1990

    • Search Google Scholar
    • Export Citation
  • 10

    Maesawa S, , Salame C, , Flickinger JC, , Pirris S, , Kondziolka D, & Lunsford LD: Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 94:1420, 2001

    • Search Google Scholar
    • Export Citation
  • 11

    Maurice-Williams RS: Neurosurgery in the elderly. Br J Neurosurg 8:651653, 1994

  • 12

    Ogungbo BI, , Kelly P, , Kane PJ, & Nath FP: Microvascular decompression for trigeminal neuralgia: report of outcome in patients over 65 years of age. Br J Neurosurg 14:2327, 2000

    • Search Google Scholar
    • Export Citation
  • 13

    Régis J, , Metellus P, , Hayashi M, , Roussel P, , Donnet A, & Bille-Turc F: Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia. J Neurosurg 104:913924, 2006

    • Search Google Scholar
    • Export Citation
  • 14

    Rhee DJ, , Kong DS, , Park K, & Lee JA: Frequency and prognosis of delayed facial palsy after microvascular decompression for hemi-facial spasm. Acta Neurochir (Wien) 148:839843, 2006

    • Search Google Scholar
    • Export Citation
  • 15

    Ryu H, , Yamamoto S, , Sugiyama K, & Nozue M: Neurovascular compression syndrome of the eighth cranial nerve. What are the most reliable diagnostic signs?. Acta Neurochir (Wien) 140:12791286, 1998

    • Search Google Scholar
    • Export Citation
  • 16

    Sheehan J, , Pan HC, , Stroila M, & Steiner L: Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors. J Neurosurg 102:434441, 2005

    • Search Google Scholar
    • Export Citation
  • 17

    Taha JM, & Tew JM Jr: Comparison of surgical treatments for trigeminal neuralgia: reevaluation of radiofrequency rhizotomy. Neurosurgery 38:865871, 1996

    • Search Google Scholar
    • Export Citation

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