Microvascular Decompression for Trigeminal Neuralgia in the Elderly: A Review of the Safety and Efficacy

Ashkan, Keyoumars; Marsh, Henry

doi:10.1227/01.neu.0000137660.06337.c5

Cited by 130 publications

(72 citation statements)

References 53 publications

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“…There is no evidence in the literature to suggest increased major complication rates following MVD that are associated with increasing age. Previous studies have analyzed the results of MVD in elderly patients and demonstrated that the outcomes and morbidity rates are not related to age 2,5) . Broggi et al 5) , along with other physicians, consider MVD in the elderly to be easier and less time-consuming to accomplish than in younger patients, primarily due to brain atrophy and larger cisterns in the former, minimizing retractionrelated complications.…”

Section: Discussionmentioning

confidence: 99%

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

Jeon

Kong

Lee

et al. 2010

J Korean Neurosurg Soc

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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.

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Section: Discussionmentioning

confidence: 99%

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

Jeon

Kong

Lee

et al. 2010

J Korean Neurosurg Soc

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“…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%

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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“…Las publicaciones de Mittal, Taha y cols. (18)(19)(20)(21)(22) consideran que la termocoagulación por radiofrecuencia y la microdescompresión vascular constituyen las variantes quirúrgicas más utilizadas en la actualidad por la alta efectividad, sin hablar de coste-efectividad, lo cual es muy difícil, teniendo en cuenta que las investigaciones relacionadas con el tema no abarcan muchas veces el concepto económico. Muchos dan preferencia a la MDV por la posibilidad de utilizarse en pacientes jóvenes evitando las alteraciones sensitivas que provoca la termocoagulación por radiofrecuencia (23)(24)(25)(26), sin embargo, en el caso de la termocoagulación por radiofrecuencia se considera más beneficiosa, además, es una técnica bien tolerada por los pacientes ancianos, incluso en los menores de 60 años que la prefieren a pesar de los trastornos sensitivos que originan.…”

Section: Discussionunclassified

Análisis de decisión: coste-efectividad en el tratamiento quirúrgico de la neuralgia del trigémino

Díaz

Suárez

Hernandez

et al. 2013

Rev. Soc. Esp. Dolor

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Introduction: Trigeminal neuralgia is a facial pain syndrome known and characterized by severe, intermittent, electric shocklike, shooting pain in the face for which a number of surgical therapies have been used. To date no ideal, minimally invasive, patient-acceptable treatment is available, hence both patients and specialists face substantial uncertainty when making decisions regarding therapeutic action.Objective: To identify which surgical treatment for TN offers the best opportunity in terms of cost-effectiveness.Material and method: A study was performed using a decision analysis/cost-effectiveness analysis design considering five surgical alternatives in the management of TN: radiofrequency thermocoagulation, glycerol microcompression, balloon microcompression, radiosurgery, and microvascular decompression. Data were obtained from the literature. A review was carried out of the MEDLINE database from 2000 to 2010 via PubMed Central. Studies were selected that addressed primary trigeminal neuralgia and demonstrated pain relief and reduced mortality and complication rates. In all 196 studies were identified but only 22 (11.22 %) were eligible for the study. The software package used

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Microvascular Decompression for Trigeminal Neuralgia in the Elderly: A Review of the Safety and Efficacy

Abstract: MVD is underused in the elderly despite being both safe and effective. Fitness and not age should be the key in deciding the treatment options. It is proposed that any patient with medically refractory TN who is fit for general anesthesia should be given the opportunity to choose MVD.

Cited by 130 publications

References 53 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

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

Análisis de decisión: coste-efectividad en el tratamiento quirúrgico de la neuralgia del trigémino

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