The effectiveness and safety of neurosurgical treatment via retrosigmoid approach in elderly patients with trigeminal neuralgia

2021 ◽  
Vol 92 ◽  
pp. 27-32
Author(s):  
Junwei Sun ◽  
Jialin Zhu ◽  
Li Zhang ◽  
Yanbing Yu
Keyword(s):  
Trigeminal Neuralgia ◽  
Elderly Patients ◽  
Retrosigmoid Approach ◽  
Neurosurgical Treatment

Typical Trigeminal Neuralgia: Comparison of Results between Patients Older and Younger than 65 Years Operated on with Microvascular Decompression by Retrosigmoid Approach

2019 ◽  
Vol 81 (01) ◽  
pp. 028-032 ◽  
Author(s):  
Luciano Mastronardi ◽  
Franco Caputi ◽  
Alessandro Rinaldi ◽  
Guglielmo Cacciotti ◽  
Raffaelino Roperto ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Elderly Patients ◽  
Microvascular Decompression ◽  
Cerebrospinal Fluid Leak ◽  
The Elderly ◽  
Retrosigmoid Approach ◽  
Younger Patients ◽  
Significant Difference ◽  
Elderly Cohort

Abstract Objective The incidence of typical trigeminal neuralgia (TN) increases with age, and neurologists and neurosurgeons frequently observe patients with this disorder at age 65 years or older. Microvascular decompression (MVD) of the trigeminal root entry zone in the posterior cranial fossa represents the etiological treatment of typical TN with the highest efficacy and durability of all treatments. This procedure is associated with possible risks (cerebellar hematoma, cranial nerve injury, stroke, and death) not seen with the alternative ablative procedures. Thus the safety of MVD in the elderly remains a topic of discussion. This study was conducted to determine whether MVD is a safe and effective treatment in older patients with TN compared with younger patients. Methods In this retrospective study, 28 patients older than 65 years (elderly cohort: mean age 70.9 ± 3.6 years) and 38 patients < 65 years (younger cohort: mean age 51.7 ± 6.3 years) underwent MVD via the keyhole retrosigmoid approach for type 1 TN (typical) or type 2a TN (typically chronic) from November 2011 to November 2017. A 75-year-old patient and three nonelderly patients with type 2b TN (atypical) were excluded. Elderly and younger cohorts were compared for outcome and complications. Results At a mean follow-up 26.0 ± 5.5 months, 25 patients of the elderly cohort (89.3%) reported a good outcome without the need for any medication for pain versus 34 (89.5%) of the younger cohort. Twenty-three elderly patients with type 1 TN were compared with 30 younger patients with type 1 TN, and no significant difference in outcomes was found (p > 0.05). Five elderly patients with type 2a TN were compared with eight younger patients with type 2a TN, and no significant difference in outcomes was noted (p > 0.05). There was one case of cerebrospinal fluid leak and one of a cerebellar hematoma, both in the younger cohort. Mortality was zero in both cohorts. Conclusions On the basis of our experience and the international literature, age itself does not seem to represent a major contraindication of MVD for TN.

Typical trigeminal neuralgia in patients older than 65: Safety and efficacy of microvascular decompression by the retrosigmoid approach

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Luciano Mastronardi ◽  
Franco Caputi ◽  
Alessandro Rinaldi ◽  
Guglielmo Cacciotti
Keyword(s):  
Trigeminal Neuralgia ◽  
Elderly Patients ◽  
Microvascular Decompression ◽  
The Elderly ◽  
Retrosigmoid Approach ◽  
Csf Leak ◽  
Old Patients ◽  
Younger Patients ◽  
Significant Difference

AbstractOBJECT: Incidence of typical trigeminal neuralgia (TN) increases with age and neurologists and neurosurgeons frequently observe patients with this disorder at the age of 65 or more. Microvascular decompression (MVD) of the trigeminal root entry zone in posterior cranial fossa is the only etiological therapy for typical TN with the highest efficacy and durability of all treatments. This procedure is associated with possible risks (cerebellar hematoma, cranial nerve injury, stroke, and death) not seen with the alternative ablative procedures. Thus, the safety of MVD in the elderly remains non definitively demonstrated. This study was conducted to determine whether MVD is a safe and effective treatment in elderly patients with TN in comparison to younger patients.METHODS: In this retrospective study, 25 patients older than 65 (mean age 70.1 ± 3.7 years) and 32 aging <65 (mean age 51.1 ± 6.2 years) underwent MVD by key-hole retrosigmoid approach for Type 1 TN (typical) or Type 2a TN (typical chronicized) from November 2011 to November 2016. A 75 y-o patient had Type 2b TN (atypical) versus 3 nonelderly patients were excluded. Elderly and younger groups were compared in relation to outcome and complication data.RESULTS: At a mean follow-up 23.0 ± 5.5 months, 22 old patients (88%) reported a very good outcome without necessity of any medication for pain, versus 28 (87,5%) of the younger group. Twenty elderly patients with Type 1 TN were compared with 24 younger patients with Type 1 TN, and no significant difference in outcomes was found (p > 0.05). Five elderly patients with Type 2a TN were compared with 8 younger patients with Type 2a TN, and no significant difference in outcomes was noted (p > 0.05). There was one case of CSF leak and one case of cerebellar hematoma both in the younger cohort. Mortality was zero in both groups.CONCLUSIONS: On the basis of our experience and of the international literature, age itself seems not to represent a major contraindication against MVD for TN. Keywords: Elderly, Microvascular Decompression, Retrosigmoid approach, Trigeminal neuralgia, Tic douloureux

Stereotactic Radiosurgery as Initial Surgical Management for Elderly Patients with Trigeminal Neuralgia

2017 ◽  
Vol 95 (3) ◽  
pp. 158-165 ◽  
Author(s):  
Jonathan Cohen ◽  
Seyed H. Mousavi ◽  
Amir H. Faraji ◽  
Berkcan Akpinar ◽  
Edward A. Monaco ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Elderly Patients ◽  
Stereotactic Radiosurgery ◽  
Surgical Management

scholarly journals Recurrent or refractory trigeminal neuralgia after microvascular decompression, radiofrequency ablation, or radiosurgery

2005 ◽  
Vol 18 (5) ◽  
pp. 1-6 ◽  
Author(s):  
Rene O. Sanchez-Mejia ◽  
Mary Limbo ◽  
Jason S. Cheng ◽  
Joaquin Camara ◽  
Mariann M. Ward ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Initial Treatment ◽  
Number Of Patients ◽  
Good Pain Relief ◽  
Facial Numbness ◽  
Neurosurgical Treatment ◽  
Lancinating Pain

Object Trigeminal neuralgia (TN) is characterized by paroxysmal lancinating pain in the trigeminal nerve distribution. When TN is refractory to medical management, patients are referred for microvascular decompression (MVD), radiofrequency ablation, or radiosurgery. After the initial treatment, patients may have refractory or recurrent symptoms requiring retreatment. The purpose of this study was to determine what factors are associated with the need for retreatment and which modality is most effective. Methods To define this population further, the authors evaluated a cohort of patients who required retreatment for TN. The mean follow-up periods were 51 months from the first treatment and 23 months from the last one, and these were comparable among treatment groups. Conclusions Trigeminal neuralgia can recur after neurosurgical treatment. In this study the authors demonstrate that the number of patients requiring retreatment is not negligible. Lower retreatment rates were seen in patients who initially underwent radiosurgery, compared with those in whom MVD or radiofrequency ablation were performed. Radiosurgery was more likely to be the final treatment for recurrent TN regardless of the initial treatment. After retreatment, the majority of patients attained complete or very good pain relief. Pain relief after retreatment correlates with postoperative facial numbness.

Microvascular decompression for trigeminal neuralgia in elderly patients

2008 ◽  
Vol 108 (4) ◽  
pp. 689-691 ◽  
Author(s):  
Raymond F. Sekula ◽  
Edward M. Marchan ◽  
Lynn H. Fletcher ◽  
Kenneth F. Casey ◽  
Peter J. Jannetta
Keyword(s):  
Trigeminal Neuralgia ◽  
Elderly Patients ◽  
Microvascular Decompression ◽  
The Elderly ◽  
Outcome Data ◽  
Control Group ◽  
Younger Patients ◽  
Telephone Interviews ◽  
Second Tier

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.

scholarly journals Automated Segmentation of Trigeminal Nerve and Cerebrovasculature in MR-Angiography Images by Deep Learning

2021 ◽  
Vol 15 ◽  
Author(s):  
Jinghui Lin ◽  
Lei Mou ◽  
Qifeng Yan ◽  
Shaodong Ma ◽  
Xingyu Yue ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Three Dimensional ◽  
Dice Similarity Coefficient ◽  
Tissue Segmentation ◽  
Anatomical Structures ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Automated Method ◽  
Neurosurgical Treatment

Trigeminal neuralgia caused by paroxysmal and severe pain in the distribution of the trigeminal nerve is a rare chronic pain disorder. It is generally accepted that compression of the trigeminal root entry zone by vascular structures is the major cause of primary trigeminal neuralgia, and vascular decompression is the prior choice in neurosurgical treatment. Therefore, accurate preoperative modeling/segmentation/visualization of trigeminal nerve and its surrounding cerebrovascular is important to surgical planning. In this paper, we propose an automated method to segment trigeminal nerve and its surrounding cerebrovascular in the root entry zone, and to further reconstruct and visual these anatomical structures in three-dimensional (3D) Magnetic Resonance Angiography (MRA). The proposed method contains a two-stage neural network. Firstly, a preliminary confidence map of different anatomical structures is produced by a coarse segmentation stage. Secondly, a refinement segmentation stage is proposed to refine and optimize the coarse segmentation map. To model the spatial and morphological relationship between trigeminal nerve and cerebrovascular structures, the proposed network detects the trigeminal nerve, cerebrovasculature, and brainstem simultaneously. The method has been evaluated on a dataset including 50 MRA volumes, and the experimental results show the state-of-the-art performance of the proposed method with an average Dice similarity coefficient, Hausdorff distance, and average surface distance error of 0.8645, 0.2414, and 0.4296 on multi-tissue segmentation, respectively.

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