Microvascular Decompression Surgery for Elderly Patients: A Study Based on Proposals from the Joint Committee of the Japan Gerontological Society and the Japan Geriatrics Society

The present study evaluated the indications for microvascular decompression (MVD) in elderly patients based on the new classification of the elderly population proposed by the joint committee of the Japan Gerontological Society and the Japan Geriatrics Society in 2017. Retrospective analysis of 171 patients with hemifacial spasm (HFS), trigeminal neuralgia (TN), and glossopharyngeal neuralgia (GPN) who underwent MVD in 2018. Patients were divided into three groups based on the proposal: old group, 75–89 years; pre-old group, 65–74 years; and not-old group, 64 years or younger. Preoperative comorbidities were divided into five types and the American Society of Anesthesiologists Physical Status (ASA-PS) was recorded. Outcome of the surgery and neurological complications were evaluated in June 2019. No decrease in activity of daily living occurred in any patient and surgical results showed no difference among the three groups. Rate of preoperative cardiovascular diseases was higher in both the pre-old and old groups compared with the not-old group (p <0.001 and Cramer V = 0.429). In terms of ASA-PS classification, only ASA-PS I and II were found, and rate of ASA-PS II was higher in the pre-old and old groups compared with the not-old group (p <0.001 and Cramer V = 0.407). Some patients suffered from elevated blood pressure after surgery, but were successfully managed. In conclusion, MVD for elderly patients can be achieved safely with careful patient selection and perioperative management. Data should be continuously accumulated for the future development of decision-making algorithm for MVD in the elderly.