Microvascular decompression for trigeminal neuralgia in elderly patients
Raymond F. Sekula Jr.
Raymond F. Sekula Jr.
Jannetta Center for Cranial Nerve Disorders, Department of Neurosurgery, Allegheny, General Hospital, Allegheny Neuroscience Institute/Drexel University College of Medicine, Pittsburgh, Pennsylvania
Edward M. Marchan
Jannetta Center for Cranial Nerve Disorders, Department of Neurosurgery, Allegheny, General Hospital, Allegheny Neuroscience Institute/Drexel University College of Medicine, Pittsburgh, Pennsylvania
Lynn H. Fletcher
Jannetta Center for Cranial Nerve Disorders, Department of Neurosurgery, Allegheny, General Hospital, Allegheny Neuroscience Institute/Drexel University College of Medicine, Pittsburgh, Pennsylvania
Kenneth F. Casey
Jannetta Center for Cranial Nerve Disorders, Department of Neurosurgery, Allegheny, General Hospital, Allegheny Neuroscience Institute/Drexel University College of Medicine, Pittsburgh, Pennsylvania
Peter J. Jannetta
Jannetta Center for Cranial Nerve Disorders, Department of Neurosurgery, Allegheny, General Hospital, Allegheny Neuroscience Institute/Drexel University College of Medicine, Pittsburgh, Pennsylvania
Although microvascular decompression (MVD) for patients with medically refractory trigeminal neuralgia (TN) is widely accepted as the treatment of choice, other “second-tier” treatments are frequently offered to elderly patients due to concerns regarding fitness for surgery. The authors sought to determine the safety and effectiveness of MVD for TN in patients older than 75 years of age.
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The authors performed a retrospective review of medical records and conducted follow-up telephone interviews with the patients. The outcome data from 25 MVD operations for TN performed in 25 patients with a mean age of 79.4 years (range 75–88 years) were compared with those of a control group of 25 younger patients with a mean age of 42.3 years (range 17–50 years) who underwent MVDs during the same 30-month period from July 2000 to December 2003.
Results
Initial pain relief was achieved in 96% of the patients in both groups (p = 1.0). There were no operative deaths in either group. After an average follow-up period of 44 and 52 months, 78 and 72% of patients in the elderly and control groups, respectively, remained pain free without medication (p = 0.74).
Conclusions
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.
Address correspondence to:Raymond F. Sekula Jr., M.D., Jannetta Center for Cranial Nerve Disorders, Department of Neurosurgery, Allegheny General Hospital, 420 East North Avenue, Suite 302, Pittsburgh, Pennsylvania 15212. email:rsekula@wpahs.org.
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