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European Geriatric Medicine

, Volume 10, Issue 6, pp 939–945 | Cite as

Microvascular decompression for treating classical trigeminal neuralgia: can we offer the gold standard therapy to older patients?

  • Isabella Nasi-KordhishtiEmail author
  • Marcos Soares Tatagiba
  • Florian Heinrich Ebner
Research Paper
  • 23 Downloads

Key summary points

Aim

The aim of the study is to investigate the intraoperative and perioperative morbidity in older patients who underwent a microvascular decompression in a surgical series.

Findings

In the performed data analyses, no significant differences between older and younger patients were detected. There were no major complications in the older patients.

Message

If a patient experiences classical trigeminal neuralgia and has no contraindication for anesthesia, a microvascular decompression should be offered even to older patients, based on the high chances of success and low morbidity.

Abstract

Purpose

Microvascular decompression is the most successful procedure for treating classic trigeminal neuralgia. However, due to the risks of surgery and anesthesia, the procedure is performed less frequently in older patients. The aim of the study is to investigate the intraoperative and perioperative morbidity in older patients who underwent this surgical treatment.

Methods

Patients who underwent microvascular decompression in our department between 2004 and 2016 were divided into two age groups (A: < 69 years old, n = 114; B: ≥ 70 years old, n = 47). Retrospectively, the pre-, intra- and postoperative data were analyzed.

Results

Older patients showed a statistically significant prolonged duration of symptoms until surgery (mean 127 months vs. 70 months; p < 0.001). They also showed a significantly increased necessity for duroplasty (p = 0.015), but with no increased incidence of postoperative cerebrospinal fluid leakage or rhinoliquorrhea. A comparable postoperative course was found in both groups. Over 90% in both groups had a significantly postoperative improvement. There were no cardiopulmonary complications or infections in either group. In the 3-month follow-up, there was a comparable success of pain reduction and no increased incidence of sensory disturbances.

Conclusions

Based on the high chances of success and low morbidity, microvascular decompression should also be offered to older patients with anesthesiologic agreement.

Keywords

Older patients Microvascular decompression Surgical outcome Trigeminal neuralgia Neurovascular conflict 

Abbreviations

AEP

Auditory evoked potentials

AICA

Anterior inferior cerebellar artery

BA

Basilar artery

CSF

Cerebrospinal fluid

MVD

Microvascular decompression

PICA

Posterior inferior cerebellar artery

SCA

Superior cerebellar artery

SD

Standard deviation

TN

Trigeminal neuralgia

VA

Vertebral artery

Notes

Acknowledgements

There was no external funding of the study.

Author contributions

INK contributed to the data acquisition, analysis and interpretation of data, statistical analysis, writing of the first draft of the manuscript and final approval. FE was responsible for the conception and design of the study, data interpretation, the review and critique of the final manuscript. MT contributed to the interpretation of the data, revision and final approval of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

This study was approved by the ethics committee of the Eberhard Karls University Tuebingen (registration no. 027/2019BO2).

Informed consent

Because of the retrospective anonymous design, informed consent could not be obtained by all patients.

References

  1. 1.
    Amirnovin R, Neimat JS, Roberts JA et al (2005) Multimodality treatment of trigeminal neuralgia. Stereotact Funct Neurosurg 83:197–201CrossRefGoogle Scholar
  2. 2.
    Apfelbaum RI (1999) Glycerol trigeminal neurolysis. Tech Neurosurg 5:225–231CrossRefGoogle Scholar
  3. 3.
    Ashkan K, Marsh H (2004) Microvascular decompression for trigeminal neuralgia in the elderly: a review of the safety and efficacy. Neurosurgery 55:840–848 (discussion 848–850) CrossRefGoogle Scholar
  4. 4.
    Barker FG 2nd, Jannetta PJ, Bissonette DJ et al (1996) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–1083CrossRefGoogle Scholar
  5. 5.
    Bilgin H, Kelebek N, Korfali G et al (2002) A rare complication of trigeminal nerve stimulation during radiofrequency thermocoagulation: sudden ST segment elevation. J Neurosurg Anesthesiol 14:47–49CrossRefGoogle Scholar
  6. 6.
    Cruccu G, Bonamico LH, Zakrzewska JM (2010) Chapter 56—cranial neuralgias. In: Aminoff MJ, Boller F, Swaab DF (eds) Handbook of clinical neurology. Elsevier, New York, pp 663–678Google Scholar
  7. 7.
    Dhople AA, Adams JR, Maggio WW et al (2009) Long-term outcomes of Gamma Knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature. Clinical article. J Neurosurg 111:351–358CrossRefGoogle Scholar
  8. 8.
    Di Stefano G, La Cesa S, Truini A et al (2014) Natural history and outcome of 200 outpatients with classical trigeminal neuralgia treated with carbamazepine or oxcarbazepine in a tertiary centre for neuropathic pain. J Headache Pain 15:34CrossRefGoogle Scholar
  9. 9.
    Engelhardt M, Uhlenbruch S, Christmann A et al (2005) Accidental dural tears occurring during supratentorial craniotomy—a prospective analysis of predisposing factors in 100 patients. Zentralbl Neurochir 66:70–74CrossRefGoogle Scholar
  10. 10.
    Gunther T, Gerganov VM, Stieglitz L et al (2009) Microvascular decompression for trigeminal neuralgia in the elderly: long-term treatment outcome and comparison with younger patients. Neurosurgery 65:477–482 (discussion 482) CrossRefGoogle Scholar
  11. 11.
    He Z, Cheng H, Wu H et al (2019) Risk factors for postoperative delirium in patients undergoing microvascular decompression. PLoS ONE 14:e0215374CrossRefGoogle Scholar
  12. 12.
    Headache Classification Committee of the International Headache S (2013) The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 33:629–808CrossRefGoogle Scholar
  13. 13.
    Huang CF, Chiou SY, Wu MF et al (2010) Gamma Knife surgery for recurrent or residual trigeminal neuralgia after a failed initial procedure. J Neurosurg 113(Suppl):172–177CrossRefGoogle Scholar
  14. 14.
    Kalkanis SN, Eskandar EN, Carter BS et al (2003) Microvascular decompression surgery in the United States, 1996–2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery 52:1251–1261 (discussion 1261–1252) CrossRefGoogle Scholar
  15. 15.
    Kanpolat Y, Savas A, Bekar A et al (2001) Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1600 patients. Neurosurgery 48:524–532 (discussion 532-524) CrossRefGoogle Scholar
  16. 16.
    Keats AS (1978) The ASA classification of physical status—a recapitulation. Anesthesiology 49:233–236CrossRefGoogle Scholar
  17. 17.
    Meng L, Quinlan JJ (2006) Assessing risk factors for postoperative nausea and vomiting: a retrospective study in patients undergoing retromastoid craniectomy with microvascular decompression of cranial nerves. J Neurosurg Anesthesiol 18:235–239CrossRefGoogle Scholar
  18. 18.
    Meng Q, Zhang W, Yang Y et al (2008) Cardiovascular responses during percutaneous radiofrequency thermocoagulation therapy in primary trigeminal neuralgia. J Neurosurg Anesthesiol 20:131–135CrossRefGoogle Scholar
  19. 19.
    Ogungbo BI, Kelly P, Kane PJ et al (2000) Microvascular decompression for trigeminal neuralgia: report of outcome in patients over 65 years of age. Br J Neurosurg 14:23–27CrossRefGoogle Scholar
  20. 20.
    Oh IH, Choi SK, Park BJ et al (2008) The treatment outcome of elderly patients with idiopathic trigeminal neuralgia: micro-vascular decompression versus gamma knife radiosurgery. J Korean Neurosurg Soc 44:199–204CrossRefGoogle Scholar
  21. 21.
    Phan K, Rao PJ, Dexter M (2016) Microvascular decompression for elderly patients with trigeminal neuralgia. J Clin Neurosci 29:7–14CrossRefGoogle Scholar
  22. 22.
    Pollock BE (2012) Surgical management of medically refractory trigeminal neuralgia. Curr Neurol Neurosci 12:125–131CrossRefGoogle Scholar
  23. 23.
    Rogers CL, Shetter AG, Fiedler JA et al (2000) Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 47:1013–1019CrossRefGoogle Scholar
  24. 24.
    Rughani AI, Dumont TM, Lin CT et al (2011) Safety of microvascular decompression for trigeminal neuralgia in the elderly. Clinical article. J Neurosurg 115:202–209CrossRefGoogle Scholar
  25. 25.
    Ruiz-Juretschke F, Vargas AJ, Gonzalez-Quarante LH et al (2017) Microsurgical treatment of trigeminal neuralgia in patients older than 70 years: an efficacy and safety study. Neurologia 32:424–430CrossRefGoogle Scholar
  26. 26.
    Sharma R, Phalak M, Katiyar V et al (2018) Microvascular decompression versus stereotactic radiosurgery as primary treatment modality for trigeminal neuralgia: a systematic review and meta-analysis of prospective comparative trials. Neurol India 66:688–694CrossRefGoogle Scholar
  27. 27.
    Yang DB, Wang ZM, Jiang DY et al (2014) The efficacy and safety of microvascular decompression for idiopathic trigeminal neuralgia in patients older than 65 years. J Craniofac Surg 25:1393–1396CrossRefGoogle Scholar
  28. 28.
    Young B, Shivazad A, Kryscio RJ et al (2013) Long-term outcome of high-dose gamma knife surgery in treatment of trigeminal neuralgia. J Neurosurg 119:1166–1175CrossRefGoogle Scholar
  29. 29.
    Young JN, Wilkins RH (1993) Partial sensory trigeminal rhizotomy at the pons for trigeminal neuralgia. J Neurosurg 79:680–687CrossRefGoogle Scholar
  30. 30.
    Yu R, Wang C, Qu C et al (2019) Study on the therapeutic effects of trigeminal neuralgia with microvascular decompression and stereotactic gamma knife surgery in the elderly. J Craniofac Surg 30:e77–e80CrossRefGoogle Scholar
  31. 31.
    Zeng YJ, Zhang H, Yu S et al (2018) Efficacy and Safety of microvascular decompression and gamma knife surgery treatments for patients with primary trigeminal neuralgia: a prospective study. World Neurosurg 116:e113–e117CrossRefGoogle Scholar
  32. 32.
    Zhao H, Tang Y, Zhang X et al (2016) Microvascular decompression for idiopathic primary trigeminal neuralgia in patients over 75 years of age. J Craniofac Surg 27:1295–1297CrossRefGoogle Scholar

Copyright information

© European Geriatric Medicine Society 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryEberhard Karls UniversityTuebingenGermany
  2. 2.Department of NeurosurgeryAlfried Krupp HospitalEssenGermany
  3. 3.Department of NeurosurgeryUniversitätsklinikum TübingenTübingenGermany

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