Skip to main content

Advertisement

SpringerLink
Log in

Advanced age as a contraindication to microvascular decompression for drug-resistant trigeminal neuralgia: evidence of prejudice?

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Due to the alleged higher risk of complications of microvascular decompression for trigeminal neuralgia in elderly we evaluated its age-related results. A retrospective analysis of clinical outcome and complications was performed in 476 patients affected by drug-resistant trigeminal neuralgia who underwent microvascular decompression. As much as 117 patients older than 65 years (Group 1) and 359 under the age of 65 (Group 2) were followed-up for a period of 7–138 months. Pain relief was complete without medication in 84.5% in Group 1. Morbidity included slight trigeminal hypoesthesia in 5.8%; severe hearing loss in 0.9%; CSF leakage in 4.2%; transient diplopia in 3.4%; and posterior fossa subdural hematoma in 0.8% of these patients. Mortality was null. No statistically significant differences were observed between Groups 1 and 2. These findings seem to support the idea that microvascular decompression is not a dangerous surgical procedure in patients over the age of 65 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dandy WE (1934) Concerning the cause of trigeminal neuralgia. Am J Surg 24:447–455

    Article  Google Scholar 

  2. Gardner WJ, Miklos MV (1959) Response of trigeminal neuralgia to decompression of sensory root. Discussion of cause of trigeminal neuralgia. JAMA 170:1773–1776

    CAS  Google Scholar 

  3. Jannetta PJ (1967) Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 26:159–162

    Article  PubMed  Google Scholar 

  4. Young RF (1997) Gamma knife radiosurgery for treatment of trigeminal neuralgia. Neurology 48:608–614

    CAS  PubMed  Google Scholar 

  5. Brown JA (2002) Trigeminal neuralgia: treatment by percutaneous balloon compression. In: Burchiel KJ (ed) Surgical management of pain. Thieme Medical Publishers, New York, pp 874–877

    Google Scholar 

  6. Kondziolka D, Lunsford LD, Flickinger JC (2002) Stereotactic radiosurgery for the treatment of trigeminal neuralgia. Clin J Pain 18:42–47

    Article  PubMed  Google Scholar 

  7. Liu JK, Apfelbaum RI (2004) Treatment of trigeminal neuralgia. Neurosurg Clin N Am 15:319–334

    Article  PubMed  Google Scholar 

  8. Petit JH, Herman JM, Nagda S et al (2003) Radiosurgical treatment of trigeminal neuralgia: evaluating quality of life and treatment outcomes. Int J Radiat Oncol Biol Phys 56:1147–1153

    Article  PubMed  Google Scholar 

  9. Pollock BE, Phuong LK, Gorman DA et al (2002) Stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 97:347–353

    Article  PubMed  Google Scholar 

  10. Goss BW, Frighetto L, DeSalles AAF et al (2003) Linear accelerator radiosurgery using 90 Gray for essential trigeminal neuralgia: results and dose volume histogram analysis. Neurosurgery 53:823–830

    Article  PubMed  Google Scholar 

  11. Jawahar A, Wadhwa R, Berk C et al (2005) Assessment of pain control, quality of life, and predictors of success after gamma knife surgery for the treatment of trigeminal neuralgia. Neurosurg Focus 15:E8

    Google Scholar 

  12. Tronnier VM, Rasche D, Hamer J et al (2001) Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. Neurosurgery 48:1261–1267

    Article  CAS  PubMed  Google Scholar 

  13. Urgosik D, Liscak R, Novotny J Jr et al (2005) Treatment of essential trigeminal neuralgia with gamma knife surgery. J Neurosurg 102(Suppl):29–33

    Article  PubMed  Google Scholar 

  14. Katusic S, Williams DB, Beard CM et al (1991) Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences, Rochester, Minnesota, 1945–1984. Neuroepidemiology 10:276–281

    Article  CAS  PubMed  Google Scholar 

  15. Merrison AF, Fuller G (2003) Treatment options for trigeminal neuralgia. BMJ 13(7428):1360–1361

    Article  Google Scholar 

  16. Tyler-Kabara EC, Kassam AB, Horowitz MH et al (2002) Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression. J Neurosurg 96:527–531

    Article  PubMed  Google Scholar 

  17. House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147

    CAS  PubMed  Google Scholar 

  18. Brock S, Scaioli V, Ferroli P et al (2004) Neurovascular decompression in trigeminal neuralgia: role of intraoperative neurophysiological monitoring in the learning period. Stereotact Funct Neurosurg 82(5–6):199–206

    Article  PubMed  Google Scholar 

  19. Katusic S, Beard CM, Bergstralh E et al (1990) Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945–84. Ann Neurol 27:89–95

    Article  CAS  PubMed  Google Scholar 

  20. Apfelbaum R (1998) Neurovascular decompression: the procedure of choice? In: Grady S (ed) Clinical neurosurgery, vol 46. Williams & Wilkins, Baltimore, Lippincott, pp 473–498

    Google Scholar 

  21. Regis J, Bartolomei F, Metellus P et al (1999) Radiosurgery for trigeminal neuralgia and epilepsy. Neurosurg Clin North Am 10:359–376

    CAS  Google Scholar 

  22. Matsuda S, Serizawa T, Sato M et al (2002) Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication. J Neurosurg 97:525–528

    Article  PubMed  Google Scholar 

  23. Abdennebi B, Mahfouf L, Nedjahi T (1997) Long-term results of percutaneous compression of the gasserian ganglion in trigeminal neuralgia (series of 200 patients). Stereotact Funct Neurosurg 68(1–4 Pt 1):190–195

    Article  CAS  PubMed  Google Scholar 

  24. Brisman R (1997) Surgical treatment of trigeminal neuralgia. Semin Neurol 17(4):367–372

    Article  CAS  PubMed  Google Scholar 

  25. Broggi G, Ferroli P, Franzini A (2008) Treatment strategy for trigeminal neuralgia: a thirty years experience. Neurol Sci 29(Suppl 1):S79–S82

    Article  PubMed  Google Scholar 

  26. Broggi G, Franzini A, Lasio G et al (1990) Long-term results of percutaneous retrogasserian thermorizotomy for “essential” trigeminal neuralgia: considerations in 1000 consecutive patients. Neurosurgery 26:783–787

    Article  CAS  PubMed  Google Scholar 

  27. 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

    Article  CAS  PubMed  Google Scholar 

  28. Fraioli B, Esposito V, Guidetti B et al (1989) Treatment of trigeminal neuralgia by thermocoagulation, glycerolization, and percutaneous compression of the gasserian ganglion and/or retrogasserian rootlets: long-term results and therapeutic protocol. Neurosurgery 24:239–245

    Article  CAS  PubMed  Google Scholar 

  29. Lobato RD, Rivas JJ, Sarabia R et al (1990) Percutaneous microcompression of the gasserian ganglion for trigeminal neuralgia. J Neurosurg 72:546–553

    Article  CAS  PubMed  Google Scholar 

  30. Meglio M, Cioni B (1989) Percutaneous procedures for trigeminal neuralgia: microcompression versus radiofrequency thermocoagulation. Personal experience. Pain 38:9–16

    Article  CAS  PubMed  Google Scholar 

  31. Sahni KS, Pieper DR, Anderson R (1990) Relation of hypesthesia to the outcome of glycerol rhizolysis for trigeminal neuralgia. J Neurosurg 72:55–58

    Article  CAS  PubMed  Google Scholar 

  32. Saini SS (1987) Retrogasserian anhydrous glycerol injection therapy in trigeminal neuralgia: observations in 552 patients. J Neurol Neurosurg Psychiatry 50:1536–1538

    Article  CAS  PubMed  Google Scholar 

  33. Peters G, Nurmikko TJ (2002) Peripheral and gasserian ganglion-level procedures for the treatment of trigeminal neuralgia. Clin J Pain 18:28–34

    Article  PubMed  Google Scholar 

  34. Barker FG II, Jannetta PJ, Bissonette DJ et al (1996) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–1083

    Article  PubMed  Google Scholar 

  35. Broggi G, Ferroli P, Franzini A et al (2000) Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 68:59–64

    Article  CAS  PubMed  Google Scholar 

  36. Apfelbaum RI (2002) Trigeminal rhizotomy. In: Burchiel KJ (ed) Surgical management of pain. Thieme Medical Publishers, New York, pp 898–902

    Google Scholar 

  37. Cho D, Chang CG, Wang Y et al (1994) Repeated operation in failed microvascular decompression for trigeminal neuralgia. Neurosurgery 35:665–670

    Article  CAS  PubMed  Google Scholar 

  38. McNatt SA, Yu C, Giannotta SL et al (2005) Gamma knife radiosurgery for trigeminal neuralgia. Neurosurgery 56:1295–1301

    Article  PubMed  Google Scholar 

  39. Levi EI, Jannetta PJ (2002) Microvascular decompression. In: Burchiel KJ (ed) Surgical management of pain. Thieme, New York, pp 878–888

    Google Scholar 

  40. McLaughlin MR, Jannetta PJ, Clyde BL et al (1999) Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 90:1–8

    Article  CAS  PubMed  Google Scholar 

  41. Ashkan K, Marsh H (2004) Microvascular decompression for trigeminal neuralgia in the elderly: a review of the safety and efficacy. Neurosurgery 55:840–848

    Article  PubMed  Google Scholar 

  42. Javadpour M, Eldridge PR, Varma TR et al (2003) Microvascular decompression for trigeminal neuralgia in patients over 70 years of age. Neurology 60:520

    CAS  PubMed  Google Scholar 

  43. Jodicke A, Winking M, Deinsberger W et al (1999) Microvascular decompression as treatment for trigeminal neuralgia in the elderly patient. Minim Invasive Neurosurg 42:92–96

    Article  CAS  PubMed  Google Scholar 

  44. 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 14:23–27

    Article  CAS  PubMed  Google Scholar 

  45. Ryu H, Yamamoto S, Sugiyama K et al (1999) Neurovascular decompression for trigeminal neuralgia in elderly patients. Neurol Med Chir 39:226–230

    Article  CAS  Google Scholar 

  46. Sekula RF Jr, Marchan EM, Fletcher LH et al (2008) Microvascular decompression for trigeminal neuralgia in elderly patients. J Neurosurg 108:689–691

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

We thank Dr. Allen Fertziger for his help in revising the manuscript.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy

    Paolo Ferroli, Francesco Acerbi, Massimo Tomei, Giovanni Tringali, Angelo Franzini & Giovanni Broggi

Authors
  1. Paolo Ferroli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco Acerbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Massimo Tomei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giovanni Tringali
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angelo Franzini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giovanni Broggi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paolo Ferroli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ferroli, P., Acerbi, F., Tomei, M. et al. Advanced age as a contraindication to microvascular decompression for drug-resistant trigeminal neuralgia: evidence of prejudice?. Neurol Sci 31, 23–28 (2010). https://doi.org/10.1007/s10072-009-0156-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-009-0156-1

Keywords

Search

Navigation