Quantitative analysis of the safety and efficacy of microvascular decompression for patients with trigeminal neuralgia above and below 65?years of age. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia Wallach, J., Ho, A. L., Kim, L. H., Chaudhuri, A. A., Chaudhary, N., Vaz-Guimaraes, F., Chang, S. D. 2018


For medically-refractory trigeminal neuralgia (TN), microvascular decompression (MVD) is the first-line treatment, and has demonstrated the greatest efficacy and durability. However, due to potential surgical complications, a bias may exist against performing MVD in elderly patients. We sought to determine through a quantitative analysis whether MVD in the elderly is a safe and effective procedure for TN. We completed a Pubmed/SCOPUS literature search up to 12/2016 for eligible studies on MVD for TN. Only research articles with age stratification of results were included. In this quantitative analysis, we analyzed the data for the six articles identified in the literature comparing MVD for a group of patients =65?years with an elderly group <65?years. A total of 1483 were included. 455 patients were =65?years (mean 70.8?years, range 65-89?years) and 1028 patients were <65?years (mean 53.4?years, range 19-64?years). Composite mean follow-up time was 51.6?months for the elderly group, and 55.1?months for the young group. Following MVD, each group had 1 mortality (p?=?0.43). There were 21 serious morbidities in the elderly group (4.62%) and 32 in the young group (3.11%) (p?=?0.11). In addition, 15 patients (1.46%) in the elderly group and 24 patients (1.62%) in the young group experienced a cerebrospinal fluid leak (p?=?0.23). TN recurrence rates 9.23% in the young group and 13.33% in the elderly group (p?=?0.070). In conclusion, for properly-selected surgical candidates, MVD should not be ruled out on the basis of age =65?years.

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