Microvascular decompression for elderly patients with trigeminal neuralgia: a prospective study and systematic review with meta-analysis

Sekula, Raymond F.; Frederickson, Andrew M.; Jannetta, Peter J.; Quigley, Matthew R.; Aziz, Khaled; Arnone, Gregory D.

doi:10.3171/2010.6.jns10142

Cited by 115 publications

(96 citation statements)

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“…However, the masticatory function and the mechanical (touch) perception were better preserved after MVD than BC. There is a lack of comparative studies that have analyzed the outcomes of different types of neurosurgery for iTN, and despite the fact that there are clear criteria for the selection of surgical modalities, 18,24,26 for a great number of patients this choice is made according to the available technique.…”

Section: Discussionmentioning

confidence: 99%

“…4 One limitation of this study is the impossibility of age matching. Although MVD is a safe procedure for patients of any age, 26 due to more severe comorbidities in older populations the younger patients were more often referred to MVD. There are age characteristics associated with the masticatory system and sensorial thresholds that could have affected, at least in part, the results obtained by this study.…”

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confidence: 99%

“…33 It is considered to have the best long-term results for iTN, with a low rate of recurrence of pain (15%-25% within 3 years) 13,23 and few collateral effects. 1,4,[20][21][22]26 The percutaneous balloon compression (BC) of the trigeminal ganglion was introduced by Mullan and Lichtor in 1983. 3,4,32 The recurrence rate after BC is 45.4% in 4 years, 19 and there is a high incidence of masticatory complications 5 and sensory deficits 9,10,29,30 after this procedure.…”

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confidence: 99%

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Sensory abnormalities and masticatory function after microvascular decompression or balloon compression for trigeminal neuralgia compared with carbamazepine and healthy controls

Ichida

Almeida

Nóbrega

et al. 2015

JNS

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There is a lack of comparative papers regarding the outcomes of neurosurgery in patients with iTN. The objective of this study was to investigate sensory thresholds and masticatory function in 78 patients with iTN who underwent microvascular decompression (MVD) or balloon compression (BC), and compare these treatments with carbamazepine and 30 untreated healthy controls. methods The authors conducted a case-controlled longitudinal study. Patients were referred to 1 of 3 groups: MVD, BC, or carbamazepine. All patients were evaluated before and after treatment with a systematic protocol composed of a clinical orofacial questionnaire, Research Diagnostic Criteria for temporomandibular disorders, Helkimo indices, and a quantitative sensory-testing protocol (gustative, olfactory, cold, warm, touch, vibration, superficial, and deep pain thresholds). results Both MVD and BC were effective at reducing pain intensity (p = 0.012) and carbamazepine doses (p < 0.001). Myofascial and articular complaints decreased in both groups (p < 0.001), but only the patients in the MVD group showed improvement in Helkimo indices (p < 0.003). Patients who underwent MVD also showed an increase in sweet (p = 0.014) and salty (p = 0.003) thresholds. The sour threshold decreased (p = 0.003) and cold and warm thresholds increased (p < 0.001) in patients after MVD and BC, but only the patients who underwent BC had an increase in touch threshold (p < 0.001). coNclusioNs Microvascular decompression and BC resulted in a reduction in myofascial and jaw articular complaints, and the impact on masticatory function according to Helkimo indices was greater after BC than MVD. MVD resulted in more gustative alterations, and both procedures caused impairment in thermal thresholds (warm and cold). However, only BC also affected touch perception. The sensorial and motor deficits after BC need to be included as targets directly associated with the success of the surgery and need to be assessed and relieved as goals in the treatment of iTN.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Sensory abnormalities and masticatory function after microvascular decompression or balloon compression for trigeminal neuralgia compared with carbamazepine and healthy controls

Ichida

Almeida

Nóbrega

et al. 2015

JNS

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“…We then divided the population into an elderly cohort and nonelderly cohort. The age used to define the elderly population has varied across publications, 29 ranging from 60 to 75 years, and therefore, we used 2 different age cutoffs to distinguish our elderly population. The data were analyzed using an age cutoff of 65 years and then reanalyzed with an age cutoff of 75 years.…”

Section: Methodsmentioning

confidence: 99%

“…As the incidence of TN increases with age, 17 the safety of MVD in the elderly population represents an important clinical question for treating physicians. Several small studies, 2,8,9,12,13,25,27,30 including a recent prospective analysis, 29 have suggested that the efficacy and safety of MVD in elderly patients are comparable with those in younger patients. Unfortunately these studies are limited by small sample sizes.…”

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Safety of microvascular decompression for trigeminal neuralgia in the elderly

Rughani

Dumont

Lin

et al. 2011

JNS

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Since its description by Jannetta, 10,11 MVD has proven to be a successful surgical treatment for TN. As the incidence of TN increases with age, 17 the safety of MVD in the elderly population represents an important clinical question for treating physicians. Several small studies, 2,8,9,12,13,25,27,30 including a recent prospective analysis, 29 have suggested that the efficacy and safety of MVD in elderly patients are comparable with those in younger patients. Unfortunately these studies are limited by small sample sizes. Utilizing a large national data set, we determined that the impact of an advanced age on perioperative complication rates associated with MVD for TN could be better elucidated. MethodsThe NIS was obtained from the Agency for Health Division of Neurosurgery, University of Vermont, Burlington, VermontObject. 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.Methods. 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.Results. 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 olde...

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Microvascular decompression for hemifacial spasm in patients >65 years of age: An analysis of outcomes and complications

et al. 2013

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Microvascular decompression for elderly patients with trigeminal neuralgia: a prospective study and systematic review with meta-analysis

Abstract: Although patient selection remains important, the authors' experience and the results of this systematic review with meta-analysis suggest that the majority of elderly patients with TN can safely undergo MVD.

Cited by 115 publications

References 37 publications

Sensory abnormalities and masticatory function after microvascular decompression or balloon compression for trigeminal neuralgia compared with carbamazepine and healthy controls

Sensory abnormalities and masticatory function after microvascular decompression or balloon compression for trigeminal neuralgia compared with carbamazepine and healthy controls

Safety of microvascular decompression for trigeminal neuralgia in the elderly

Microvascular decompression for hemifacial spasm in patients >65 years of age: An analysis of outcomes and complications

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