Microvascular decompression for trigeminal neuralgia in elderly patients

Sekula, Raymond F.; Marchan, Edward M.; Fletcher, Lynn H; Casey, Kenneth F.; Jannetta, Peter J.

doi:10.3171/jns/2008/108/4/0689

Cited by 70 publications

(38 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There was also no difference in terms of length of hospital stay between the two groups. These results agree with the few reports that appear in the literature 14,18) . The most frequently reported complications of MVD include hearing loss, diplopia, facial palsy, brainstem or cerebellar infarct, hematoma, ataxia, CSF leak, meningitis, and hydrocephalus 4,15) .…”

Section: Discussionsupporting

confidence: 83%

The Efficacy and Safety of Microvascular Decompression for Hemifacial Spasm in Elderly Patients

Jeon

Kong

Lee

et al. 2010

J Korean Neurosurg Soc

View full text Add to dashboard Cite

Objective : The purpose of this study was to examine the efficacy and safety of microvascular decompression (MVD) for hemifacial spasm (HFS) in elderly patients. Methods : Between 1997 and June 2008, 1,174 patients had undergone MVD for HFS at our institute. Among these, 53 patients were older than 65 years. We retrospectively reviewed and compared the complication and the cure rates of these patients with those of younger patients. Results : There were 38 females and 15 males. The mean duration of symptoms of HFS of these patients was 94.6 months (range, 12-360 months), compared with 67.2 months (range, 3-360 months) in the younger group. The overall cure rate in elderly patients who underwent MVD for HFS during this period was 96.2%. Permanent cranial nerve dysfunctions, such as hearing loss and facial palsy, were seen in 2 patients (3.8%, 2/53) in the elderly group and 19 patients (1.7%, 19/1121) in the younger group. The difference in permanent cranial nerve dysfunction between the two groups was not statistically significant. There was no operative mortality in either group. Conclusion : Microvascular decompression is the most effective surgical modality available for the treatment of HFS. Results of this study indicate that such technique can be performed in the elderly without higher rates of morbidity or mortality. Any patient with HFS, whose general health is acceptable for undergoing general anesthesia, should be considered as a candidate for MVD.

show abstract

Section: Discussionsupporting

confidence: 83%

The Efficacy and Safety of Microvascular Decompression for Hemifacial Spasm in Elderly Patients

Jeon

Kong

Lee

et al. 2010

J Korean Neurosurg Soc

View full text Add to dashboard Cite

show abstract

“…Because of its high rate of success, MVD is considered by many to be the optimal initial treatment for typical TN in young and elderly otherwise healthy adults. 1,17 In considering MVD for TN, the utility of distinguishing between the various subtypes of TN is becoming clearer. In reviewing Jannetta's 7 results over a 24-year period, Tyler-Kabara et al 23 have shown that patients with typical TN fare far better than those with atypical TN.…”

Section: Discussionmentioning

confidence: 99%

Microvascular decompression in patients with isolated maxillary division trigeminal neuralgia, with particular attention to venous pathology

Sekula

Frederickson²,

Jannetta³

et al. 2009

FOC

Self Cite

View full text Add to dashboard Cite

Object The authors have the clinical impression that patients with isolated V2, or maxillary division, trigeminal neuralgia (TN) are most often women of a younger age with atypical pain features and a predominance of venous compression as the pathology. The aim of this study was to evaluate a specific subgroup of patients with V2 TN. Methods Among 120 patients who underwent microvascular decompression (MVD) for TN in 2007, data were available for 114; 6 patients were lost to follow-up. Patients were stratified according to typical (Burchiel Type 1), mixed (Burchiel Type 2a), or atypical (Burchiel Type 2b) TN. A pain-free status without medication was used to determine the efficacy of MVD. All patients were contacted in June 2008 and again in January 2009 at 12–24 months after surgery (median 18.4 months) and asked to rate their response to MVD as excellent (complete pain relief without medication), fair (complete pain relief with medication or some relief with or without medication), or poor (continued pain despite medication; that is, no change from their preoperative baseline pain status. Results Of 114 patients, 14 (12%) had isolated V2 TN. Among these 14 were 2 typical (14%), 1 mixed (7%), and 11 atypical cases (79%) of TN. Among the remaining 100 cases were 37 typical (37%), 14 mixed (14%), and 49 atypical cases (49%) of TN. In the isolated V2 TN group, all patients were women as compared with 72% of women in the larger group of 100 patients (p = 0.05, chi-square test). The average age in the isolated V2 TN group was 51.2 years (median 48.1 years) versus 54.2 years (median 54.0 years) in the remainder of the group (p = NS, unpaired Student t-test). In the isolated V2 TN group, there was a predominance of atypical pain cases (79%) versus 49% in the remainder of the group, and this finding trended toward statistical significance (p = 0.07, chi-square test). Venous contact or compression (partly or wholly) was noted in 93% of the patients with isolated V2 versus 69% of the remainder of the group (p = 0.13, chi-square test). The likelihood of excellent outcomes in the patients with V2 TN (71%) was compared with that in typical pain cases (79%) among patients in the rest of the group (that is, the bestoutcome group), and no difference was found between the 2 groups (p = 0.8, chi-square test). Conclusions The authors confirmed that patients with isolated V2 TN were more likely to be female, tended toward an atypical pain classification with venous pathology at surgery, and fared just as well as those presenting with typical pain.

show abstract

“…3,22,32 As the world's population ages, the safety of MVD in older persons has become a topic of increased interest. 2,8,9,12,13,25,27,29,30 To date, the safety of MVD in older patients has been examined through several small case series, which were * CHF = congestive heart failure. …”

Section: Discussionmentioning

confidence: 99%

“…The age cutoffs range from 60 years in 1 study, 2 65 years in 4 studies, 8,9,25 70 years in 1 study, 12 to 75 years in 2 studies. 27,30 Cumulatively, these studies examine 441 older patients, with attention to multiple complications including death, stroke, cerebellar hematoma, cranial nerve injury, CSF leak, and infection. Authors of these studies independently report that older patients do not have an increased risk of death, stroke, cerebellar hematoma, or cranial neuropathy, and this conclusion remains when analyzed collectively through a meta-analysis.…”

Section: Fig 3 Bar Graphs Demonstrating the Average Hospital Los (Lmentioning

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.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Safety of microvascular decompression for trigeminal neuralgia in the elderly

Rughani

Dumont

Lin

et al. 2011

JNS

View full text Add to dashboard Cite

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...

show abstract

Microvascular decompression for trigeminal neuralgia in elderly patients

Abstract: Microvascular decompression is an effective treatment for elderly patients with TN. The authors' experience suggests that the rate of complications and death after MVD for TN in elderly patients is no different from the rate in younger patients.

Cited by 70 publications

References 14 publications

The Efficacy and Safety of Microvascular Decompression for Hemifacial Spasm in Elderly Patients

The Efficacy and Safety of Microvascular Decompression for Hemifacial Spasm in Elderly Patients

Microvascular decompression in patients with isolated maxillary division trigeminal neuralgia, with particular attention to venous pathology

Safety of microvascular decompression for trigeminal neuralgia in the elderly

Contact Info

Product

Resources

About