Abstract
ObjectiveThe safety and efficacy of surgical microvascular decompression (MVD) in elderly patients with trigeminal neuralgia (TN) is controversially discussed in the literature. A widespread reluctance to expose this cohort to major intracranial surgery persists. Our aim was to compare the efficacy and safety between older and younger patients with TN.MethodsIn this cross-sectional study, 139 MVD procedures (103 patients < 70 and 36 patients ≥ 70) were included. Surgical fitness was assessed by the American Society of Anesthesiology (ASA) grade. The pain-free interval was evaluated using Kaplan–Meier analysis only in patients with a recent follow-up visit. Independent risk factors for recurrence in patients with a minimum 12-month follow-up were determined.ResultsPatients ≥ 70 showed a significantly higher number of comorbidities. Pain intensity, affection of trigeminal branches and symptom duration was similar between groups. No significant difference in treatment associated complications and permanent neurological deficits was shown. There was no treatment-related mortality. A tendency towards a lower recurrence rate in patients < 70 did not reach statistical significance (17.6% vs. 28.6%, P = 0.274). Pain-free interval was not different between both cohorts (78.7 vs. 73.5 months, P = 0.391).ConclusionDespite a higher prevalence of comorbidities in elderly patients, complication rates and neurological deficits after MVD were comparable to younger patients. Rates of immediate and long-term pain relief compared favorably to previous studies and were similar between elderly and younger patients. These data endorse MVD as a safe and effective first-line surgical procedure for elderly patients with TN and neurovascular conflict on MRI.
Highlights
Classical trigeminal neuralgia (TN) is a chronic pain disorder manifesting with unilateral paroxysmal stabbing pain involving one or more divisions of the trigeminal nerve
The purpose of this study was to analyze the neurological outcome and TN recurrence rates in patients beyond 70 years of age in comparison to younger patients to add more definitive data to the mixed reports on that topic. In this single-center cross-sectional study, we reviewed the medical records of 485 consecutive patients undergoing surgical procedures to treat trigeminal neuralgia between 01/2012 and 02/2020
This study offers convincing new aspects that substantiate the justification of microvascular decompression (MVD) in elderly patients
Summary
Classical trigeminal neuralgia (TN) is a chronic pain disorder manifesting with unilateral paroxysmal stabbing pain involving one or more divisions of the trigeminal nerve. It is the most prevalent facial pain syndrome and pain onset is usually between the ages of 40 and 60. Anticonvulsant medication is the first-line therapy and can reduce TN pain intensity in 75% of patients [10]. The efficacy of conservative treatment generally decreases over time and TN is frequently resistant to multidrug treatment regimens.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
