Typical Trigeminal Neuralgia: Comparison of Results between Patients Older and Younger than 65 Years Operated on with Microvascular Decompression by Retrosigmoid Approach

Abstract

Objective The incidence of typical trigeminal neuralgia (TN) increases with age, and neurologists and neurosurgeons frequently observe patients with this disorder at age 65 years or older. Microvascular decompression (MVD) of the trigeminal root entry zone in the posterior cranial fossa represents the etiological treatment of typical TN with the highest efficacy and durability of all treatments. This procedure is associated with possible risks (cerebellar hematoma, cranial nerve injury, stroke, and death) not seen with the alternative ablative procedures. Thus the safety of MVD in the elderly remains a topic of discussion. This study was conducted to determine whether MVD is a safe and effective treatment in older patients with TN compared with younger patients.

Methods In this retrospective study, 28 patients older than 65 years (elderly cohort: mean age 70.9 ± 3.6 years) and 38 patients < 65 years (younger cohort: mean age 51.7 ± 6.3 years) underwent MVD via the keyhole retrosigmoid approach for type 1 TN (typical) or type 2a TN (typically chronic) from November 2011 to November 2017. A 75-year-old patient and three nonelderly patients with type 2b TN (atypical) were excluded. Elderly and younger cohorts were compared for outcome and complications.

Results At a mean follow-up 26.0 ± 5.5 months, 25 patients of the elderly cohort (89.3%) reported a good outcome without the need for any medication for pain versus 34 (89.5%) of the younger cohort. Twenty-three elderly patients with type 1 TN were compared with 30 younger patients with type 1 TN, and no significant difference in outcomes was found (p > 0.05). Five elderly patients with type 2a TN were compared with eight younger patients with type 2a TN, and no significant difference in outcomes was noted (p > 0.05). There was one case of cerebrospinal fluid leak and one of a cerebellar hematoma, both in the younger cohort. Mortality was zero in both cohorts.

Conclusions On the basis of our experience and the international literature, age itself does not seem to represent a major contraindication of MVD for TN.

Keywords

elderly - microvascular decompression - retrosigmoid approach - trigeminal neuralgia - tic douloureux

• References

• 1 Laghmari M, El Ouahabi A, Arkha Y, Derraz S, El Khamlichi A. Are the destructive neurosurgical techniques as effective as microvascular decompression in the management of trigeminal neuralgia?. Surg Neurol 2007; 68 (05) 505-512
• 2 Cowan JA, Brahma B, Sagher O. Surgical treatment of trigeminal neuralgia: comparison of microvascular decompression, percutaneous ablation, and stereotactic radiosurgery. Techn Neurosurg 2003; 8: 157-167
• 3 Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988; 8 (Suppl. 07) 1-96
• 4 Gardner WJ. Concerning the mechanism of trigeminal neuralgia and hemifacial spasm. J Neurosurg 1962; 19: 947-958
• 5 Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 1967; 26 (01) 159-162
• 6 Kabatas S, Karasu A, Civelek E, Sabanci AP, Hepgul KT, Teng YD. Microvascular decompression as a surgical management for trigeminal neuralgia: long-term follow-up and review of the literature. Neurosurg Rev 2009; 32 (01) 87-93 ; discussion 93–94
• 7 Klun B. Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal neuralgia: personal experience with 220 patients. Neurosurgery 1992; 30 (01) 49-52
• 8 Barker II FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 1996; 334 (17) 1077-1083
• 9 Sindou M, Leston JM, Decullier E, Chapuis F. Microvascular decompression for trigeminal neuralgia: the importance of a noncompressive technique—Kaplan-Meier analysis in a consecutive series of 330 patients. Neurosurgery 2008; 63 (04) (Suppl. 02) 341-350 ; discussion 350–351
• 10 Taha JM, Tew Jr JM. Comparison of surgical treatments for trigeminal neuralgia: reevaluation of radiofrequency rhizotomy. Neurosurgery 1996; 38 (05) 865-871
• 11 Burchiel KJ, Steege TD, Howe JF, Loeser JD. Comparison of percutaneous radiofrequency gangliolysis and microvascular decompression for the surgical management of tic douloureux. Neurosurgery 1981; 9 (02) 111-119
• 12 Tronnier VM, Rasche D, Hamer J, Kienle AL, Kunze S. Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. Neurosurgery 2001; 48 (06) 1261-1267 ; discussion 1267–1268
• 13 Jawahar A, Wadhwa R, Berk C. , et al. Assessment of pain control, quality of life, and predictors of success after gamma knife surgery for the treatment of trigeminal neuralgia. Neurosurg Focus 2005; 18 (05) E8
• 14 Di Scipio E, Mastronardi L. CE-Chirp® ABR in cerebellopontine angle surgery neuromonitoring: technical assessment in four cases. Neurosurg Rev 2015; 38 (02) 381-384 ; discussion 384
• 15 Javadpour M, Eldridge PR, Varma TR, Miles JB, Nurmikko TJ. Microvascular decompression for trigeminal neuralgia in patients over 70 years of age. Neurology 2003; 60 (03) 520
• 16 Ashkan K, Marsh H. Microvascular decompression for trigeminal neuralgia in the elderly: a review of the safety and efficacy. Neurosurgery 2004; 55 (04) 840-848 ; discussion 848–850
• 17 Günther T, Gerganov VM, Stieglitz L, Ludemann W, Samii A, Samii M. Microvascular decompression for trigeminal neuralgia in the elderly: long-term treatment outcome and comparison with younger patients. Neurosurgery 2009; 65 (03) 477-482 ; discussion 482
• 18 Qiang WS, Duan YP, Zhang JZ. , et al. Microvascular decompression for trigeminal neuralgia in elderly patients. Chin J Neuromed 2009; 8: 399-404
• 19 Zhao WG, Xue YH, Shen JK. , et al. Etiology of trigeminal neuralgia in elderly patients and its management with microvascular decompression. Chin J Geriatr 2005; 24: 441-443
• 20 Singh D, Jagetia A, Sinha S. Brain stem infarction: a complication of microvascular decompression for trigeminal neuralgia. Neurol India 2006; 54 (03) 325-326
• 21 Masuoka J, Matsushima T, Hikita T, Inoue E. Cerebellar swelling after sacrifice of the superior petrosal vein during microvascular decompression for trigeminal neuralgia. J Clin Neurosci 2009; 16 (10) 1342-1344
• 22 Kalkanis SN, Eskandar EN, Carter BS, Barker II FG. Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery 2003; 52 (06) 1251-1261 ; discussion 1261–1262
• 23 Sweet WH. The treatment of trigeminal neuralgia (tic douloureux). N Engl J Med 1986; 315 (03) 174-177
• 24 Wallach J, Ho AL, Kim LH. , et al. Quantitative analysis of the safety and efficacy of microvascular decompression for patients with trigeminal neuralgia above and below 65 years of age. J Clin Neurosci 2018; 55: 13-16