Author: Helen Tyzack

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Safety of microvascular decompression for elderly patients with trigeminal neuralgia

Research article: Safety of microvascular decompression for elderly patients with trigeminal neuralgia

The following is an excerpt of a longer article which can be read in the journal, Clinical Neurology and Neurosurgery, Volume 141, February 2016, Pages 77-8. Authors: Kenichi Amagasaki, Saiko Watanabe, Kazuaki Naemura, Naoyuki Shono, and Hiroshi Nakaguchi. More detail can be located online at: https://www.sciencedirect.com/science/article/abs/pii/S0303846715301062

 Objective

The study compared the safety and efficacy of microvascular decompression (MVD) in groups of elderly patients and non-elderly patients with medically refractory trigeminal neuralgia (TN) and collected detailed perioperative data.

Methods

Retrospective analysis of clinical data was performed in 99 patients who underwent MVD from May 2012 to June 2015. The outcome data from 27 MVD operations for 27 patients aged 70–80 years (mean 74.6 years) were compared with 72 MVD operations with 72 patients aged 25–69 years (mean 55.7 years). Preoperative comorbidities were recorded and postoperative worsening comorbidities and non-neurological complications were evaluated at discharge. Efficacy of the surgery and neurological complications were evaluated in July 2015.

Introduction

MVD is often described as the most effective treatment to achieve initial and long-term pain control for TN. However, percutaneous procedures have also showed good results, and both percutaneous procedures and MVD provide acceptable outcomes. TN occurs more frequently with higher age, but older patients are thought to have higher risks for surgery and anaesthesia compared to younger patients. Consequently, some surgeons are reluctant to operate on older patients, especially as other therapeutic options are available. No single large study of MVD in the elderly has been possible due to the small sample size. A meta-analysis and a report based on the National Inpatient Sample in the United States published in 2011 provide a representative large series of the elderly. The conclusions were that MVD in the elderly deserved consideration, but we believe that more clinical data is desirable.

The present study evaluated the safety as well as efficacy of MVD in a group of elderly patients compared with the non-elderly patients, including detailed perioperative and management data.

Results

No decrease in activity of daily living was found in any patient. Complete pain relief without medication was achieved in 77.8% and partial pain relief in 14.8% in the elderly group, and 83.3% and 9.7%, respectively, in the non-elderly group (p = 0.750). Permanent neurological complication was not observed in the elderly group, whereas 5th nerve and 8th nerve complications were observed in the non-elderly group. Rates of preoperative multiple comorbidities and of cardiovascular comorbidity were significantly higher in the elderly group (p<.01). Worsening comorbidity and new pathology at discharge were mainly hypertension in both groups, but glaucoma attack and asthma attack were observed in the elderly group. All pathologies were successfully managed.

Conclusion

MVD for elderly patients with TN can be achieved safely with careful perioperative management. Surgeons should be experienced to shorten the duration of surgical time and reduce narcotic use, and careful assessment of comorbidity and sharing the information with all medical staff is essential. All staff should work as a team to avoid worsening comorbidity and always consider the possibility of unpredictable events in elderly patients.

 Editor’s note: Member, Helen Tyzack, recalls that when she was considering having my MVD, her neurosurgeon told her he had conducted this operation on 90 year olds. He made his decision not on age rather on the relative health and condition of a person. If you are elderly, and you are in pain, I recommend you contact one of Medical Advisory Board’s neurosurgeons and seek their advice. The four neurosurgeons on our MAB are:

  • Associate Professor Mark Dexter (West Sydney) Phone 02 9633 1900
  • Dr Jeremy Russell (Melbourne) Phone 03 9981 9588
  • Dr Benjamin Jonker (Sydney) at Central Neurosurgery Phone 1300 17 44 97
  • Associate Professor Andrew Danks (Melbourne) Phone 03 8513 9906

If you need to travel to any of these specialists, and need financial assistance, please remember that every state of Australia has some form of Patient Travel Assistance Scheme. If you don’t have access to the internet, I recommend you ask your GP to look up the details for you, and print out any necessary forms.

 

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The Trigeminal Neuralgia Association Australia has existed for 20 years!

Early in 2003 Irene Wood took the initiative and organised for the Incorporation of the Trigeminal Neuralgia Association Australia. After connecting with a handful of sufferers, Irene established the Sydney Support Group. For around 15 years Irene, as President, presided over an organisation which offered support and information with monthly newsletters, biannual conferences that brought together some of Australia’s and the world’s leading experts in research and treatment, a website and the bringing together of many of the nation’s top specialists as a Medical Advisory Board. Over time people put up their hands and volunteered to run Support Group Meetings in other states.

In 2017 Irene handed the reins to Kathryn Meredith who, during many terms of office, compiled an informative newsletter regularly, and oversaw a conference and the start of an upgrade to the website. She led a team of committed volunteers that kept the organisation going.

In 2022, Lyn Donnelly took the helm. During the past 12 months she continued with the website upgrading process, opened a YouTube account and designed, produced and distributed promotional TNAA branded products. All these activities increased the visibility of our organisation. Membership numbers increased as a result of the increased frequency of adding information onto the website, publication of a monthly Enews email, and through the webinars featuring experts in the field of trigeminal neuralgia. In addition, more members felt encouraged to volunteer their services.

Starting as a voluntary run organisation, the operation hasn’t changed. These days a seven person committee and eight Support Group Leaders are all that stand between our organisation as a vital going concern and being wound up. Financially the organisation has depended on membership fees, donations from members and major gifts from a couple of supporters. We have never received any government funding. That is, the past 20 years has been an extraordinary achievement with only a small band of people who, as volunteers, have been committed to letting sufferers know there are treatments, advice and support: that they are not alone with their trigeminal neuralgia pain.

Thanks to everyone who has made it all possible.