Microvascular Decompression for Treatment of Trigeminal Neuralgia: Factors That Predict Complete Pain Relief and Study of Efficacy and Safety in Older Patients

OBJECTIVE: Microvascular decompression (MVD) is an effective method for directly treating the etiology of trigeminal neuralgia (TGN). This study aims to investigate the factors that predict complete pain relief after MVD for treatment of TGN, and to study efficacy and safety in older patients. METHODS: This study was conducted in patients with TGN that were treated by MVD at Siriraj Hospital between 2004 and 2015. Cases with secondary TGN were excluded. Data was gathered from medical records, preoperative magnetic resonance imaging, intraoperative findings, and by telephone in patients lost to follow-up. RESULTS: Of 110 included patients, 68 and 42 patients were younger and older than 60 years, respectively. Median age was 53.6 years old. Typical type of TGN, paroxysmal pain, large offending vessel on preoperative magnetic resonance imaging, and multiple locations of trigeminal nerve compression were associated with early postoperative pain-free status. No variables were associated with long-term outcome. Multivariate analysis using binary logistic regression revealed typical type of TGN to be the only factor associated with early postoperative pain-free status. No significant difference was observed between the <60 and >= 60 age groups for surgical outcome and rate of complications. CONCLUSIONS: Presence of typical type TGN was the only factor found to independently predict a pain-free outcome in the early postoperative period. No factors were associated long-term pain-free outcome. MVD is an effective and safe operative procedure, and it should be regarded as a safe and viable alternative for treating intractable TGN in older patients.