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
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.
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.
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.
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.
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.