Microvascular Decompression as Treatment of Trigeminal Neuralgia in the Elderly Patient

1999 ◽  
Vol 42 (02) ◽  
pp. 92-96 ◽  
Author(s):  
A. Jödicke ◽  
M. Winking ◽  
W. Deinsberger ◽  
D.-K. Böker
Keyword(s):  
Elderly Patient ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
The Elderly

scholarly journals An age-dependent outcome analysis of microvascular decompression and percutaneous thermocoagulation in trigeminal neuralgia

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Naureen Keric ◽  
Darius Kalasauskas ◽  
Sophia L. Kreth ◽  
Martin B. Glaser ◽  
Harald Krenzlin ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Complication Rate ◽  
Age Groups ◽  
Treatment Strategies ◽  
The Elderly ◽  
Outcome Analysis ◽  
Neurovascular Compression ◽  
Duration Of Symptoms ◽  
Ganglion Gasseri

Abstract Background Trigeminal neuralgia (TN) is a severe pain condition and the most common facial neuralgia. While microvascular decompression (MVD) presents an excellent treatment in neurovascular compression cases, percutaneous thermocoagulation (PT) of the ganglion Gasseri is an alternative option. This study aimed to evaluate post-operative complication rate and outcome of both treatment strategies related to the patient’s age. Methods The medical records of all patients with the diagnosis of trigeminal neuralgia undergoing an MVD or PT of the ganglion Gasseri (between January 2007 and September 2017) were reviewed to determine the efficacy and the complication rate of both methods in regard to the patient’s age. Results Seventy-nine patients underwent MVD surgery and 39 a PT. The mean age of patients in the MVD group was 61 years and 73 years in the PT group. There were 59 (50%) female patients. Nerve-vessel conflict could be identified in 78 (98.7%) MVD and 17 (43.6%) PT patients on preoperative MRI. Charlson comorbidity index was significantly higher in PT group (2.4 (1.8) versus 3.8 (1.8) p < 0.001). The Barrow pain score (BPS) at the last follow-up demonstrated higher scores after PT (p = 0.007). The complication rate was markedly higher in PT group, mostly due to the facial hypesthesia (84.6% versus 27.8%; p < 0.001). Mean symptom-free survival was significantly shorter in the PT group (9 vs. 26 months, p < 0.001). It remained statistically significant when stratified into age groups: (65 years and older: 9 vs. 18 months, p = 0.001). Duration of symptoms (OR 1.005, 95% CI 1.000–1.010), primary procedure (OR 6.198, 95% CI 2.650–14.496), patient age (OR 1.033, 95% CI 1.002–1.066), and postoperative complication rate (OR 2.777, 95% CI 1.309–5.890) were associated with treatment failure. Conclusion In this patient series, the MVD is confirmed to be an excellent treatment option independent of patient’s age. However, while PT is an effective procedure, time to pain recurrence is shorter, and the favorable outcome (BPS 1 and 2) rate is lower compared to MVD. Hence MVD should be the preferred treatment and PT should remain an alternative in very selected cases when latter is not possible but not in the elderly patient per se.

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.

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 Microvascular decompression in trigeminal neuralgia: predictors of pain relief, complication avoidance, and lessons learned

2021 ◽  
Author(s):  
Johannes Herta ◽  
Tobias Schmied ◽  
Theresa Bettina Loidl ◽  
Wei-te Wang ◽  
Wolfgang Marik ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
The Elderly ◽  
Pain Intensity Score ◽  
Complication Rates ◽  
Safe Procedure ◽  
Neurovascular Conflict ◽  
Paroxysmal Pain

Abstract Objective To analyze characteristics associated with long-term pain relief after microvascular decompression (MVD) for trigeminal neuralgia (TGN). Description of associated morbidity and complication avoidance. Methods One hundred sixty-five patients with TGN underwent 171 MVD surgeries at the authors’ institution. Patient characteristics and magnetic resonance imaging (MRI) datasets were obtained through the hospital’s archiving system. Patients provided information about pre- and post-operative pain characteristics and neurologic outcome. Favorable outcome was defined as a Barrow Neurological Institute (BNI) pain intensity score of I to III with post-operative improvement of I grade. Results Type of TGN pain with purely paroxysmal pain (p = 0.0202*) and TGN classification with classical TGN (p = 0.0372*) were the only significant predictors for long-term pain relief. Immediate pain relief occurred in 90.6% of patients with a recurrence rate of 39.4% after 3.5 ± 4.6 years. MRI reporting of a neurovascular conflict had a low negative predictive value of 39.6%. Mortality was 0% with major complications observed in 8.2% of patients. Older age was associated with lower complication rates (p = 0.0009***). Re-MVD surgeries showed improved long-term pain relief in four out of five cases. Conclusions MVD is a safe and effective procedure even in the elderly. It has the unique potential to cure TGN if performed on a regular basis, and if key surgical steps are respected. Early MVD should be offered in case of medical treatment failure and paroxysmal pain symptoms. The presence of a neurovascular conflict on MRI is not mandatory. In case of recurrence, re-MVD is a good treatment option that should be discussed with patients. Highlights • Long-term analysis of pain relief after MVD. • Positive predictors for outcome: classical TGN and purely paroxysmal pain. • Presence of neurovascular conflict in MRI is not mandatory for MVD surgery. • Analysis of complications and surgical nuances for avoidance. • MVD is a safe procedure also in the elderly.

Microvascular Decompression for Trigeminal Neuralgia in the Elderly: A Review of the Safety and Efficacy

Neurosurgery ◽  
2004 ◽  
Vol 55 (4) ◽  
pp. 840-850 ◽  
Author(s):  
Keyoumars Ashkan ◽  
Henry Marsh
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Older Patients ◽  
Treatment Options ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Outcome Data ◽  
Control Group ◽  
Control Groups ◽  
And Control

Abstract OBJECTIVE: To critically examine the efficacy and safety of microvascular decompression (MVD) for trigeminal neuralgia (TN) in elderly patients. METHODS: We performed a retrospective review of medical records, followed by prospective follow-up. The outcome data from 44 MVD operations for TN performed in 40 consecutive patients with a mean age of 65 years (range, 60–75 yr) in the period 1991 to 2001 were compared with those from 40 younger control subjects (mean age, 46 yr; range, 20–59 yr) operated on during the same period. RESULTS: The median time from diagnosis of TN to MVD in the older patients was 7 years (range, 1–22 yr), compared with 3 years (range, 3 mo to 20 yr) in the younger group (P = 0.02). With the exception of one, all patients in this study were classified as American Society of Anesthesiologist Grade 1 or 2. Initial pain relief was achieved in 98 and 100% of the patients in the study and control groups, respectively. There were no operative mortalities or life-threatening morbidities. Transient facial numbness and diplopia occurred in both groups. Headaches, nausea, and vomiting were more frequent in the younger patients, whereas wound infection and confusion were more common in the older patients. The mean length of hospital stay was 5.4 days (range, 3–10 d) for the older patients, compared with 5.3 days (range, 3–9 d) for the control group (P = 0.4). After average follow-ups of 30 and 33 months, the pain recurred in 24 and 27% of the patients in the elderly and control groups, respectively. CONCLUSION: MVD is underused in the elderly despite being both safe and effective. Fitness and not age should be the key in deciding the treatment options. It is proposed that any patient with medically refractory TN who is fit for general anesthesia should be given the opportunity to choose MVD.

MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA IN THE ELDERLY

Neurosurgery ◽  
2009 ◽  
Vol 65 (3) ◽  
pp. 477-482 ◽  
Author(s):  
Thomas Günther ◽  
Venelin M. Gerganov ◽  
Lennart Stieglitz ◽  
Wolf Ludemann ◽  
Amir Samii ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
The Elderly ◽  
Safe Procedure ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Younger Patients ◽  
The Mean

Abstract OBJECTIVE Multiple studies have proved that microvascular decompression (MVD) is the treatment of choice in cases of medically refractory trigeminal neuralgia (TN). In the elderly, however, the surgical risks related to MVD are assumed to be unacceptably high and various alternative therapies have been proposed. We evaluated the outcomes of MVD in patients aged older than 65 years of age and compared them with the outcomes in a matched group of younger patients. The focus was on procedure-related morbidity rate and long-term outcome. METHODS This was a retrospective study of 112 patients with TN operated on consecutively over 22 years. The main outcome measures were immediate and long-term postoperative pain relief and neurological status, especially function of trigeminal, facial, and cochlear nerves, as well as surgical complications. A questionnaire was used to assess long-term outcome: pain relief, duration of a pain-free period, need for pain medications, time to recurrence, pain severity, and need for additional treatment. RESULTS The mean age was 70.35 years. The second and third branches of the trigeminal nerve were most frequently affected (37.3%). The mean follow-up period was 90 months (range, 48–295 months). Seventy-five percent of the patients were completely pain free, 11% were never pain free, and 14% experienced recurrences. No statistically significant differences existed in the outcome between the younger and older patient groups. Postoperative morbidity included trigeminal hypesthesia in 6.25%, hypacusis in 5.4%, and complete hearing loss, vertigo, and partial facial nerve palsy in 0.89% each. Cerebrospinal fluid leak and meningitis occurred in 1 patient each. There were no mortalities in both groups. CONCLUSION MVD for TN is a safe procedure even in the elderly. The risk of serious morbidity or mortality is similar to that in younger patients. Furthermore, no significant differences in short- and long-term outcome were found. Thus, MVD is the treatment of choice in patients with medically refractory TN, unless their general condition prohibits it.

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