Older Patients Have Better Pain Outcomes Following Microvascular Decompression for Trigeminal Neuralgia

• Published in: Neurosurgery Vol. 84; no. 1; pp. 116 - 122
• Main Authors: Bick, Sarah K, Huie, David, Sneh, Gabriel, Eskandar, Emad N
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.01.2019; Copyright by the Congress of Neurological Surgeons; Wolters Kluwer Health, Inc
• Subjects: Age; Care and treatment; Elderly patients; Electronic records; Humans; Male identity; Medical records; Medical research; Microvascular Decompression Surgery - adverse effects; Middle Aged; Nature; Neuralgia; Older people; Pain; Pain, Postoperative - epidemiology; Patient outcomes; Regression analysis; Retrospective Studies; Treatment Outcome; Trigeminal neuralgia; Trigeminal Neuralgia - epidemiology; Trigeminal Neuralgia - surgery; Massachusetts; Microvascular decompression; Age; Trigeminal neuralgia
• ISSN: 0148-396X; 1524-4040; 1524-4040
• DOI: 10.1093/neuros/nyy011

Abstract BACKGROUND Trigeminal neuralgia (TN) increases in prevalence with age. Although microvascular decompression (MVD) is the most effective long-term operative treatment for TN, its use in older patient populations has been debated due to its invasive nature. Recent studies have demonstrated safety of MVD in older patients; however, efficacy data are more limited. OBJECTIVE To determine the relationship between age and pain outcomes following MVD for TN. METHODS Subjects underwent MVD for TN at our institution between 1/1/2004 and 12/31/2013, had typical TN, and demonstrated neurovascular compression on preoperative imaging. We performed a retrospective case series study by reviewing the electronic medical records and performing phone interviews to determine long-term outcomes. We divided patients into 2 groups for analysis, under 60 and 60 yr of age and older. RESULTS One hundred twenty-four subjects were included in the study, 82 under 60, and 42 60 yr of age and older. The average length of follow-up was 42.4 mo. Patients in the older age group had average pain score of 1.57 at most recent follow-up, while for the younger age group it was 2.18 (P = .0084). Multiple regression analysis found that older age, male gender, and preoperative medication responsiveness were significantly correlated with lower long-term pain scores, while V2 dermatome involvement was correlated with higher long-term pain scores. CONCLUSION Patients 60 yr of age and older have significantly better long-term pain outcomes following MVD than younger patients.