Microvascular decompression for trigeminal neuralgia in the elderly: A review of the safety and efficacy

Keyoumars Ashkan, Henry Marsh, Kim Burchiel, Phillip Berryhill, Albino Bricolo, Peter J. Jannetta, Kenneth F. Casey, Marc P. Sindou, Giovanni Broggi

Research output: Contribution to journalArticle

94 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)840-850
Number of pages11
JournalNeurosurgery
Volume55
Issue number4
DOIs
StatePublished - Oct 2004
Externally publishedYes

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Microvascular Decompression Surgery
Trigeminal Neuralgia
Safety
Control Groups
Length of Stay
Pain
Confusion
Diplopia
Hypesthesia
Wound Infection
General Anesthesia
Nausea
Vomiting
Medical Records
Headache

Keywords

  • Efficacy
  • Elderly
  • Microvascular decompression
  • Safety
  • Trigeminal neuralgia

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Microvascular decompression for trigeminal neuralgia in the elderly : A review of the safety and efficacy. / Ashkan, Keyoumars; Marsh, Henry; Burchiel, Kim; Berryhill, Phillip; Bricolo, Albino; Jannetta, Peter J.; Casey, Kenneth F.; Sindou, Marc P.; Broggi, Giovanni.

In: Neurosurgery, Vol. 55, No. 4, 10.2004, p. 840-850.

Research output: Contribution to journalArticle

Ashkan, K, Marsh, H, Burchiel, K, Berryhill, P, Bricolo, A, Jannetta, PJ, Casey, KF, Sindou, MP & Broggi, G 2004, 'Microvascular decompression for trigeminal neuralgia in the elderly: A review of the safety and efficacy', Neurosurgery, vol. 55, no. 4, pp. 840-850. https://doi.org/10.1227/01.NEU.0000137660.06337.C5
Ashkan, Keyoumars ; Marsh, Henry ; Burchiel, Kim ; Berryhill, Phillip ; Bricolo, Albino ; Jannetta, Peter J. ; Casey, Kenneth F. ; Sindou, Marc P. ; Broggi, Giovanni. / Microvascular decompression for trigeminal neuralgia in the elderly : A review of the safety and efficacy. In: Neurosurgery. 2004 ; Vol. 55, No. 4. pp. 840-850.
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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.",
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AU - Berryhill, Phillip

AU - Bricolo, Albino

AU - Jannetta, Peter J.

AU - Casey, Kenneth F.

AU - Sindou, Marc P.

AU - Broggi, Giovanni

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N2 - 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.

AB - 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.

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