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Efficacy and complications of microvascular decompression in patients over 70 years with trigeminal neuralgia

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Abstract

Objective

Treatment of choice for trigeminal neuralgia (TN) by neurovascular conflict in case of failure of medical treatment is microvascular decompression (MVD). It is a safe and effective technique in the short and long term. But what about older patients who are considered more fragile anesthetically and surgically? Our Objective is to demonstrate the efficacy and complication rate of microvascular decompression (MVD) for older and younger patients with trigeminal neuralgia (TN) due to neurovascular conflict.

Methods

102 patients with TN due to neurovascular conflict were included (June 2005–December 2016) in a single Regional hospital. 25 were included in the group composed of ≥ 70-year-old patients (G1), while 77 were included in the < 70-year-old group (G2). The patients were operated on by the same surgical team using a retro-sigmoid approach to access the neurovascular conflict. The epidemiologic, clinical, anesthetic, and surgical data were extracted.

Results

The immediate efficacy of surgical treatment (BNI pain intensity = I) was 96% in G1 and 96.10% in the G2 group (p = 0.71). At 3-year follow-up, the efficacy rate was 89% and 86%, respectively (p = 0.93). At 5 years, it was 92% and 92% (p = 0.98). Complication rates were comparable between the two groups (20% versus 27%; p = 0.47) and no deaths occurred despite the fact that G1 group had worst preoperative anesthetic score (ASA-NYHA).

Conclusion

MVD is a durable procedure in patients over 70 years of age diagnosed with essential TN. The complication rate and immediate-, medium-, and long-term efficacy were similar to those of younger patients.

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On demand to the corresponding author.

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Abbreviations

ASA:

American Society of Anesthesiology

BMI:

Body mass index

CPA:

Cardiopulmonary arrest

CSF:

Cerebrospinal fluid leakage

ENT:

Ear, nose and throat

HED:

Extradural hematoma

MVD:

Microvascular decompression

NYHA:

New York Heart Association

PFP:

Peripheral facial palsy

SCA:

Superior cerebellar artery

TN:

Trigeminal neuralgia

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Funding

No funding was received for this research.

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Authors and Affiliations

  1. Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Reims, 45 rue Cognacq Jay, Reims, France

    Charles Domages, Esteban Brenet, Marc Labrousse, André Chays & Xavier Dubernard

  2. Department of Neurosurgery, Head and Neck Surgery, University Hospital of Reims, 45 rue Cognacq Jay, Reims, France

    Arnaud Bazin & Jean-Charles Kleiber

  3. Institute of Otoneurosurgery of Champagne-Ardenne, Head and Neck Surgery, University Hospital of Reims, 45 rue Cognacq Jay, Reims, France

    Arnaud Bazin, André Chays, Jean-Charles Kleiber & Xavier Dubernard

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  1. Charles Domages
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  2. Esteban Brenet
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  7. Xavier Dubernard
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Contributions

XD coordinated and supervised the study, interpreted the data, drafted the initial manuscript, and reviewed and revised the manuscript and approved the version published and agree to be accountable for all aspects of the work. CD collected data, drafted the initial manuscript, and reviewed and revised the manuscript and approved the version published and agree to be accountable for all aspects of the work. AC and AB conceptualized and designed the study and reviewed and revised the manuscript and approved the version published and agree to be accountable for all aspects of the work. EE, JCK, MAL and ML critically interpretated the data and reviewed the manuscript for important intellectual content and approved the version published and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Xavier Dubernard.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Reims IRB hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Domages, C., Brenet, E., Labrousse, M. et al. Efficacy and complications of microvascular decompression in patients over 70 years with trigeminal neuralgia. Acta Neurol Belg 122, 615–623 (2022). https://doi.org/10.1007/s13760-022-01922-3

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  • DOI: https://doi.org/10.1007/s13760-022-01922-3

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