Neurovascular Decompression for Trigeminal Neuralgia in Elderly Patients

Ryu, Hiroshi; Yamamoto, Seiji; Sugiyama, Kenji; Yokota, Naoki; Tanaka, Tokutaro

doi:10.2176/nmc.39.226

Cited by 46 publications

(21 citation statements)

References 23 publications

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“…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.…”

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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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Section: Discussionmentioning

confidence: 99%

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

confidence: 99%

mentioning

confidence: 99%

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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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“…Several papers have concluded that MVD for patients over 65 has outcomes were similar to younger patients without an increase in the risk of serious morbidity or mortality. [41][42][43] Thus, MVD appears to be safe and effective even for older patients with trigeminal neuralgia if their general medical condition is stable and the aim of treatment is complete pain relief without medications.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Cost-Effectiveness Study of Trigeminal Neuralgia Surgery

Pollock¹,

Ecker²

2005

The Clinical Journal of Pain

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This analysis supports the practice of percutaneous surgeries for older patients with medically unresponsive trigeminal neuralgia. At longer follow-up intervals, microvascular decompression is predicted to be the most cost-effective surgery and should be considered the preferred operation for patients if their risk for general anesthesia is acceptable. More data are needed to assess the role that radiosurgery should play in the management of patients with trigeminal neuralgia.

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“…[2] Complications have followed sacrifice of the superior petrosal veins. [11218192122272930323336394042] Anatomic studies have focused on preventing such complications. [142335] This report calls attention to a unique variant in which the superior petrosal veins and sinus are absent, and the petrosal group of veins is drained by tributaries of the galenic and the tentorial groups.…”

Section: Introductionmentioning

confidence: 99%

Absence of the superior petrosal veins and sinus: Surgical considerations

Matsushima¹,

Ribas²,

Kiyosue³

et al. 2015

Surg Neurol Int

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Background:The superior petrosal vein, one of the most constant and largest drainage pathways in the posterior fossa, may result in complications if occluded. This study calls attention to a unique variant in which the superior petrosal veins and sinus were absent unilaterally, and the venous drainage was through the galenic and tentorial drainage groups.Methods:This study examines one venogram and another anatomic specimen in which the superior petrosal vein and sinus were absent.Results:The superior petrosal veins, described as 1–3 bridging veins, emptying into the superior petrosal sinus, are the major drainage pathways of the petrosal group of posterior fossa veins. In the cases presented, the superior petrosal vein and sinus were absent and venous drainage was through the galenic and tentorial groups, including the lateral mesencephalic or bridging vein on the tentorial cerebellar surface.Conclusions:In cases in which the superior petrosal sinus and veins are absent, care should be directed to preserving the collateral drainage through the galenic and tentorial tributaries. Although surgical strategies for intraoperative management and preservation of venous structures are still controversial, knowledge of the possible anatomical variations is considered to be essential to improve surgical outcomes.

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Neurovascular Decompression for Trigeminal Neuralgia in Elderly Patients

Cited by 46 publications

References 23 publications

Safety of microvascular decompression for trigeminal neuralgia in the elderly

Safety of microvascular decompression for trigeminal neuralgia in the elderly

A Prospective Cost-Effectiveness Study of Trigeminal Neuralgia Surgery

Absence of the superior petrosal veins and sinus: Surgical considerations

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