Efficacy and safety of microvascular decompression for the treatment of elderly patients with trigeminal neuralgia

Abstract

Objective To analyze the efficacy and safety of microvascular decompression (MVD) for the treatment of elderly patients with trigeminal neuralgia (TN). Methods A total of 286 primary TN patients [50 cases of age ≥ 70 years (older group) and 236 cases of age < 70 years (younger group)] underwent MVD via suboccipital sigmoid approach. Postoperative complications were recorded, including facial numbness of operation side, hearing loss of operation side, cerebrospinal fluid (CSF) leakage, poor wound healing, intracranial infection and hydrocephalus. Barrow Neurological Institute (BNI) grade was used to evaluate the relief of TN before and after surgery and during the follow-up. The recurrence rate during follow-up period was recorded. Results Of all cases, 36 (12.59%) presented with postoperative complications, including 18 cases (6.29%) of facial numbness of operation side, 13 cases (4.55%) of hearing loss of operation side, one case (0.35%) of CSF leakage, one case (0.35%) of poor wound healing, 2 cases (0.70% ) of intracranial infection and one case (0.35% ) of hydrocephalus. In those 36 cases, 29 cases (12.29% ) were in younger group and 7 cases (14% ) were in older group, and there was no significant difference between 2 groups (χ² = 0.110, P = 0.740). The mean follow-up period was 29.43 months. During the follow-up, 170 cases (78.70%) had complete pain relief (BNI gradeⅠ), 10 cases (4.63%) had partial pain relief (BNI gradeⅡ-Ⅲ), 14 cases (6.48%) had no pain relief (BNI grade Ⅳ-Ⅴ), and 22 (10.19%) recurred TN in 216 cases of the younger group; 35 cases (79.55%) had complete pain relief (BNI gradeⅠ), 2 cases (4.55%) had partial pain relief (BNI grade Ⅱ-Ⅲ), one case (2.27%) had no pain relief (BNI grade Ⅳ- Ⅴ), and 6 cases (13.64% ) recurred TN in 44 cases of the older group. There was no significant difference on prognosis between 2 groups (χ² = 1.530, P = 0.675). Kaplan-Meier curve showed the rate of complete pain relief was decreased with time.  Conclusions Pure MVD for treating elderly patients with TN is safe and effective, without postoperative death or severe complications.

DOI: 10.3969/j.issn.1672-6731.2018.09.008