Abstract

Trigeminal neuralgia (TN) is a debilitating orofacial pain disorder. Recent national database data suggests that microvascular decompression (MVD) in frail patients is associated with higher post-operative complications. However, long-term pain outcomes of frail TN patients are not known. We aimed to elucidate the relationship between frailty and long-term pain outcomes following MVD for TN.From 2007 to 2020, 368 TN patients 60 years of age or older were treated via MVD at our institution. Patient demographics, clinical characteristics, post-operative complications and long-term pain outcomes were recorded. Frailty was assessed by modified frailty index-5 (mFI-5) score and patients were dichotomized into non-frail (mFI-5 < 2) and frail (mFI-5 > 1). Differences were assessed via t-test, Chi-squared, multivariate ordinal regression, and Cox proportional hazards analysis.Of the 368 patients analyzed, 9.8% were frail. Frail patients were significantly older (p=0.02) with higher body mass index (p=0.01) and greater incidence of comorbidities (p<0.001). Frail patients presented with significantly higher pain levels at final follow-up (p=0.04). On multivariate analysis, frailty was independently associated with higher pain at follow-up (p=0.01), along with younger age, female sex, and black race. The relationship between frailty and post-operative pain recurrence trended towards significance (p=0.06), while younger age and black race were significantly associated with recurrence.Frail patients undergoing MVD are at risk for worse long-term pain outcomes. Our study provides clinicians with useful information pertaining to the influence of frailty on long-term efficacy of MVD in treating TN.

View details for DOI 10.1016/j.wneu.2023.10.009

View details for PubMedID 37821032