Microvascular decompression for treating classical trigeminal neuralgia: can we offer the gold standard therapy to older patients?
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Key summary points
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.
In the performed data analyses, no significant differences between older and younger patients were detected. There were no major complications in the older patients.
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.
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.
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.
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.
Based on the high chances of success and low morbidity, microvascular decompression should also be offered to older patients with anesthesiologic agreement.
KeywordsOlder patients Microvascular decompression Surgical outcome Trigeminal neuralgia Neurovascular conflict
Auditory evoked potentials
Anterior inferior cerebellar artery
Posterior inferior cerebellar artery
Superior cerebellar artery
There was no external funding of the study.
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.
This study was approved by the ethics committee of the Eberhard Karls University Tuebingen (registration no. 027/2019BO2).
Because of the retrospective anonymous design, informed consent could not be obtained by all patients.
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