Safety of microvascular decompression for trigeminal neuralgia in the elderly. Clinical article

Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA.
Journal of Neurosurgery (Impact Factor: 3.74). 05/2011; 115(2):202-9. DOI: 10.3171/2011.4.JNS101924
Source: PubMed


Microvascular decompression (MVD) offers an effective and durable treatment for patients suffering from trigeminal neuralgia (TN). Because the disorder has a tendency to occur in older persons, the risks of surgical treatment in the elderly have been a topic of recent interest. To date, evidence derived from several small retrospective and a single prospective case series has suggested that age does not increase the complication rate associated with surgery. Using a large national database, the authors aimed to study the impact of age on in-hospital complications following MVD for TN.
Using the Nationwide Inpatient Sample (NIS) for the 10-year period from 1999 to 2008, the authors selected all patients who underwent MVD for TN. The primary outcome of interest was the in-hospital mortality rate. Secondary outcomes of interest were cardiac, pulmonary, thromboembolic, cerebrovascular, and wound complications as well as the duration of hospital stay, total hospital charges, and discharge location. An elderly cohort of patients was first defined as those 65 years of age and older and then redefined as those 75 years and older.
A total of 3273 patients who underwent MVD for TN were identified, having a median age of 57 years. Within this sample, 31.5% were 65 years and older and 10.7% were 75 years and older. The in-hospital mortality rate was 0.68% for patients 65 years or older (p = 0.0087) and 1.16% for those 75 years or older (p = 0.0026). In patients younger than 65 years, the in-hospital mortality rate was 0.13% (3 deaths among 2241 patients). As analyzed using the chi-square test (for both 65 and 75 years as the age cutoff) and the Pearson rank correlation coefficient, the risk of cardiac, pulmonary, thromboembolic, and cerebrovascular complications was higher in older patients (that is, those 65 and older and those 75 and older), but the risks of wound complications and CNS infection were not. The risk of any in-hospital complication occurring in a patient 65 years and older was 7.36% (p < 0.0001) and 10.0% in those 75 years and older (p < 0.0001). There was no difference in the total hospital charges associated with age. The duration of the hospital stay was longer in older patients, and the likelihood of discharge home was lower in older patients.
Microvascular decompression for TN in the elderly population remains a reasonable surgical option. However, based on data from a large national database, authors of the present study suggest that complications do tend to gradually increase in tandem with an advanced age. While age does not act as a risk factor in isolation, it may serve as a convenient surrogate for complication rates. The authors hope that this information can be of use in guiding older patients through decisions for the surgical treatment of TN.

19 Reads
  • Source
    • "The cause in such cases may be focal compression (and associated myelin loss) affecting a part of nerve but not recognized during surgery9). Because all of our cases showed compression intraoperatively, we may hypothesize that vascular compression of the trigeminal nerve, especially at the REZ, is the main etiological factor in primary TN8,20). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this prospective study was to demonstrate the influence of some factors on the prognosis of microvascular decompression in 37 patients with trigeminal neuralgia. The results of microvascular decompression (MVD) in 37 patients with trigeminal neuralgia were evaluated at 6 months after surgery and were compared with clinical and operative findings. The sex of the patient, the patient's age at surgery, the side of the pain, and the duration of symptoms before surgery did not play any significant roles in prognosis. Also, the visual analogue scale (VAS) of the patient, the duration of each pain attack, and the frequency of pain over 24 hours did not play any significant roles in prognosis. In addition, intraoperative detection of the type of conflicting vessel, the degree of severity of conflict, and the location of the conflict around the circumference of the root did not play any roles in prognosis. The only factors affecting the prognosis in MVD surgery were intraoperative detection of the site of the conflict along the root and neuroradiological compression signs on preoperative magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA). These findings demonstrated that if neurovascular compression is seen on preoperative MRI/MRA and/or compression is found intraoperative at the root entry zone, then the patient will most likely benefit from MVD surgery.
    Journal of Korean Neurosurgical Society 07/2012; 52(1):42-7. DOI:10.3340/jkns.2012.52.1.42 · 0.64 Impact Factor
  • Journal of Neurosurgery 05/2011; 115(2):201; discussion 201. DOI:10.3171/2011.3.JNS11280 · 3.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Neurovascular compression syndromes are diseases caused by abnormal contact between a vessel loop and the root exit/entry zone of a cranial nerve. Compression can cause paroxysmal attacks of abnormal motor or sensory phenomena in the affected nerve. Review based on a selective analysis of the literature. Neurovascular compression syndromes include well-established entities such as trigeminal neuralgia, facial hemispasm, vestibular paroxysmia and glossopharyngeus neuralgia but also cranial nerve disorders caused by compression due to an aneurysm, e. g., oculomotor nerve paresis caused by an aneurysm of the posterior communicating branch. An overview of neurovascular compression syndromes is given, outlining diagnostic procedures and the morphological imaging features of each syndrome as well as the changes seen after treatment are described. Neurovascular compression syndromes are complex diseases. MR imaging plays an important role in the diagnostic workup of these diseases.
    RöFo - Fortschritte auf dem Gebiet der R 12/2011; 184(3):220-8. DOI:10.1055/s-0031-1281976 · 1.40 Impact Factor
Show more