Microvascular decompression for treating classical trigeminal neuralgia: can we offer the gold standard therapy to older patients?

Key summary pointsAimThe aim of the study is to investigate the intraoperative and perioperative morbidity in older patients who underwent a microvascular decompression in a surgical series.FindingsIn the performed data analyses, no significant differences between older and younger patients were detected. There were no major complications in the older patients.MessageIf a patient experiences classical trigeminal neuralgia and has no contraindication for anesthesia, a microvascular decompression should be offered even to older patients, based on the high chances of success and low morbidity. AbstractPurposeMicrovascular decompression is the most successful procedure for treating classic trigeminal neuralgia. However, due to the risks of surgery and anesthesia, the procedure is performed less frequently in older patients. The aim of the study is to investigate the intraoperative and perioperative morbidity in older patients who underwent this surgical treatment.MethodsPatients who underwent microvascular decompression in our department between 2004 and 2016 were divided into two age groups (A: <69 years old, n=114; B: <greater than or equal to>70 years old, n=47). Retrospectively, the pre-, intra- and postoperative data were analyzed.ResultsOlder patients showed a statistically significant prolonged duration of symptoms until surgery (mean 127 months vs. 70 months; p<0.001). They also showed a significantly increased necessity for duroplasty (p=0.015), but with no increased incidence of postoperative cerebrospinal fluid leakage or rhinoliquorrhea. A comparable postoperative course was found in both groups. Over 90% in both groups had a significantly postoperative improvement. There were no cardiopulmonary complications or infections in either group. In the 3-month follow-up, there was a comparable success of pain reduction and no increased incidence of sensory disturbances.ConclusionsBased on the high chances of success and low morbidity, microvascular decompression should also be offered to older patients with anesthesiologic agreement.