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Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety
OBJECTIVE: The safety and efficacy of surgical microvascular decompression (MVD) in elderly patients with trigeminal neuralgia (TN) is controversially discussed in the literature. A widespread reluctance to expose this cohort to major intracranial surgery persists. Our aim was to compare the efficac...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880960/ https://www.ncbi.nlm.nih.gov/pubmed/32862244 http://dx.doi.org/10.1007/s00415-020-10187-w |
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author | Greve, Tobias Tonn, Joerg-Christian Mehrkens, Jan-Hinnerk |
author_facet | Greve, Tobias Tonn, Joerg-Christian Mehrkens, Jan-Hinnerk |
author_sort | Greve, Tobias |
collection | PubMed |
description | OBJECTIVE: The safety and efficacy of surgical microvascular decompression (MVD) in elderly patients with trigeminal neuralgia (TN) is controversially discussed in the literature. A widespread reluctance to expose this cohort to major intracranial surgery persists. Our aim was to compare the efficacy and safety between older and younger patients with TN. METHODS: In this cross-sectional study, 139 MVD procedures (103 patients < 70 and 36 patients ≥ 70) were included. Surgical fitness was assessed by the American Society of Anesthesiology (ASA) grade. The pain-free interval was evaluated using Kaplan–Meier analysis only in patients with a recent follow-up visit. Independent risk factors for recurrence in patients with a minimum 12-month follow-up were determined. RESULTS: Patients ≥ 70 showed a significantly higher number of comorbidities. Pain intensity, affection of trigeminal branches and symptom duration was similar between groups. No significant difference in treatment associated complications and permanent neurological deficits was shown. There was no treatment-related mortality. A tendency towards a lower recurrence rate in patients < 70 did not reach statistical significance (17.6% vs. 28.6%, P = 0.274). Pain-free interval was not different between both cohorts (78.7 vs. 73.5 months, P = 0.391). CONCLUSION: Despite a higher prevalence of comorbidities in elderly patients, complication rates and neurological deficits after MVD were comparable to younger patients. Rates of immediate and long-term pain relief compared favorably to previous studies and were similar between elderly and younger patients. These data endorse MVD as a safe and effective first-line surgical procedure for elderly patients with TN and neurovascular conflict on MRI. |
format | Online Article Text |
id | pubmed-7880960 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-78809602021-02-18 Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety Greve, Tobias Tonn, Joerg-Christian Mehrkens, Jan-Hinnerk J Neurol Original Communication OBJECTIVE: The safety and efficacy of surgical microvascular decompression (MVD) in elderly patients with trigeminal neuralgia (TN) is controversially discussed in the literature. A widespread reluctance to expose this cohort to major intracranial surgery persists. Our aim was to compare the efficacy and safety between older and younger patients with TN. METHODS: In this cross-sectional study, 139 MVD procedures (103 patients < 70 and 36 patients ≥ 70) were included. Surgical fitness was assessed by the American Society of Anesthesiology (ASA) grade. The pain-free interval was evaluated using Kaplan–Meier analysis only in patients with a recent follow-up visit. Independent risk factors for recurrence in patients with a minimum 12-month follow-up were determined. RESULTS: Patients ≥ 70 showed a significantly higher number of comorbidities. Pain intensity, affection of trigeminal branches and symptom duration was similar between groups. No significant difference in treatment associated complications and permanent neurological deficits was shown. There was no treatment-related mortality. A tendency towards a lower recurrence rate in patients < 70 did not reach statistical significance (17.6% vs. 28.6%, P = 0.274). Pain-free interval was not different between both cohorts (78.7 vs. 73.5 months, P = 0.391). CONCLUSION: Despite a higher prevalence of comorbidities in elderly patients, complication rates and neurological deficits after MVD were comparable to younger patients. Rates of immediate and long-term pain relief compared favorably to previous studies and were similar between elderly and younger patients. These data endorse MVD as a safe and effective first-line surgical procedure for elderly patients with TN and neurovascular conflict on MRI. Springer Berlin Heidelberg 2020-08-30 2021 /pmc/articles/PMC7880960/ /pubmed/32862244 http://dx.doi.org/10.1007/s00415-020-10187-w Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Communication Greve, Tobias Tonn, Joerg-Christian Mehrkens, Jan-Hinnerk Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety |
title | Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety |
title_full | Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety |
title_fullStr | Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety |
title_full_unstemmed | Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety |
title_short | Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety |
title_sort | microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety |
topic | Original Communication |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880960/ https://www.ncbi.nlm.nih.gov/pubmed/32862244 http://dx.doi.org/10.1007/s00415-020-10187-w |
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