Top

Published in:

01-02-2010 | Original Article

Advanced age as a contraindication to microvascular decompression for drug-resistant trigeminal neuralgia: evidence of prejudice?

Authors: Paolo Ferroli, Francesco Acerbi, Massimo Tomei, Giovanni Tringali, Angelo Franzini, Giovanni Broggi

Published in: Neurological Sciences | Issue 1/2010

Abstract

Due to the alleged higher risk of complications of microvascular decompression for trigeminal neuralgia in elderly we evaluated its age-related results. A retrospective analysis of clinical outcome and complications was performed in 476 patients affected by drug-resistant trigeminal neuralgia who underwent microvascular decompression. As much as 117 patients older than 65 years (Group 1) and 359 under the age of 65 (Group 2) were followed-up for a period of 7–138 months. Pain relief was complete without medication in 84.5% in Group 1. Morbidity included slight trigeminal hypoesthesia in 5.8%; severe hearing loss in 0.9%; CSF leakage in 4.2%; transient diplopia in 3.4%; and posterior fossa subdural hematoma in 0.8% of these patients. Mortality was null. No statistically significant differences were observed between Groups 1 and 2. These findings seem to support the idea that microvascular decompression is not a dangerous surgical procedure in patients over the age of 65 years.

Dandy WE (1934) Concerning the cause of trigeminal neuralgia. Am J Surg 24:447–455CrossRef

Gardner WJ, Miklos MV (1959) Response of trigeminal neuralgia to decompression of sensory root. Discussion of cause of trigeminal neuralgia. JAMA 170:1773–1776

Jannetta PJ (1967) Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 26:159–162CrossRefPubMed

Young RF (1997) Gamma knife radiosurgery for treatment of trigeminal neuralgia. Neurology 48:608–614PubMed

Brown JA (2002) Trigeminal neuralgia: treatment by percutaneous balloon compression. In: Burchiel KJ (ed) Surgical management of pain. Thieme Medical Publishers, New York, pp 874–877

Kondziolka D, Lunsford LD, Flickinger JC (2002) Stereotactic radiosurgery for the treatment of trigeminal neuralgia. Clin J Pain 18:42–47CrossRefPubMed

Liu JK, Apfelbaum RI (2004) Treatment of trigeminal neuralgia. Neurosurg Clin N Am 15:319–334CrossRefPubMed

Petit JH, Herman JM, Nagda S et al (2003) Radiosurgical treatment of trigeminal neuralgia: evaluating quality of life and treatment outcomes. Int J Radiat Oncol Biol Phys 56:1147–1153CrossRefPubMed

Pollock BE, Phuong LK, Gorman DA et al (2002) Stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 97:347–353CrossRefPubMed

10.

Goss BW, Frighetto L, DeSalles AAF et al (2003) Linear accelerator radiosurgery using 90 Gray for essential trigeminal neuralgia: results and dose volume histogram analysis. Neurosurgery 53:823–830CrossRefPubMed

11.

Jawahar A, Wadhwa R, Berk C et al (2005) Assessment of pain control, quality of life, and predictors of success after gamma knife surgery for the treatment of trigeminal neuralgia. Neurosurg Focus 15:E8

12.

Tronnier VM, Rasche D, Hamer J et al (2001) Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. Neurosurgery 48:1261–1267CrossRefPubMed

13.

Urgosik D, Liscak R, Novotny J Jr et al (2005) Treatment of essential trigeminal neuralgia with gamma knife surgery. J Neurosurg 102(Suppl):29–33CrossRefPubMed

14.

Katusic S, Williams DB, Beard CM et al (1991) Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences, Rochester, Minnesota, 1945–1984. Neuroepidemiology 10:276–281CrossRefPubMed

15.

Merrison AF, Fuller G (2003) Treatment options for trigeminal neuralgia. BMJ 13(7428):1360–1361CrossRef

16.

Tyler-Kabara EC, Kassam AB, Horowitz MH et al (2002) Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression. J Neurosurg 96:527–531CrossRefPubMed

17.

House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147PubMed

18.

Brock S, Scaioli V, Ferroli P et al (2004) Neurovascular decompression in trigeminal neuralgia: role of intraoperative neurophysiological monitoring in the learning period. Stereotact Funct Neurosurg 82(5–6):199–206CrossRefPubMed

19.

Katusic S, Beard CM, Bergstralh E et al (1990) Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945–84. Ann Neurol 27:89–95CrossRefPubMed

20.

Apfelbaum R (1998) Neurovascular decompression: the procedure of choice? In: Grady S (ed) Clinical neurosurgery, vol 46. Williams & Wilkins, Baltimore, Lippincott, pp 473–498

21.

Regis J, Bartolomei F, Metellus P et al (1999) Radiosurgery for trigeminal neuralgia and epilepsy. Neurosurg Clin North Am 10:359–376

22.

Matsuda S, Serizawa T, Sato M et al (2002) Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication. J Neurosurg 97:525–528CrossRefPubMed

23.

Abdennebi B, Mahfouf L, Nedjahi T (1997) Long-term results of percutaneous compression of the gasserian ganglion in trigeminal neuralgia (series of 200 patients). Stereotact Funct Neurosurg 68(1–4 Pt 1):190–195CrossRefPubMed

24.

Brisman R (1997) Surgical treatment of trigeminal neuralgia. Semin Neurol 17(4):367–372CrossRefPubMed

25.

Broggi G, Ferroli P, Franzini A (2008) Treatment strategy for trigeminal neuralgia: a thirty years experience. Neurol Sci 29(Suppl 1):S79–S82CrossRefPubMed

26.

Broggi G, Franzini A, Lasio G et al (1990) Long-term results of percutaneous retrogasserian thermorizotomy for “essential” trigeminal neuralgia: considerations in 1000 consecutive patients. Neurosurgery 26:783–787CrossRefPubMed

27.

Kanpolat Y, Savas A, Bekar A et al (2001) Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1600 patients. Neurosurgery 48:524–532CrossRefPubMed

28.

Fraioli B, Esposito V, Guidetti B et al (1989) Treatment of trigeminal neuralgia by thermocoagulation, glycerolization, and percutaneous compression of the gasserian ganglion and/or retrogasserian rootlets: long-term results and therapeutic protocol. Neurosurgery 24:239–245CrossRefPubMed

29.

Lobato RD, Rivas JJ, Sarabia R et al (1990) Percutaneous microcompression of the gasserian ganglion for trigeminal neuralgia. J Neurosurg 72:546–553CrossRefPubMed

30.

Meglio M, Cioni B (1989) Percutaneous procedures for trigeminal neuralgia: microcompression versus radiofrequency thermocoagulation. Personal experience. Pain 38:9–16CrossRefPubMed

31.

Sahni KS, Pieper DR, Anderson R (1990) Relation of hypesthesia to the outcome of glycerol rhizolysis for trigeminal neuralgia. J Neurosurg 72:55–58CrossRefPubMed

32.

Saini SS (1987) Retrogasserian anhydrous glycerol injection therapy in trigeminal neuralgia: observations in 552 patients. J Neurol Neurosurg Psychiatry 50:1536–1538CrossRefPubMed

33.

Peters G, Nurmikko TJ (2002) Peripheral and gasserian ganglion-level procedures for the treatment of trigeminal neuralgia. Clin J Pain 18:28–34CrossRefPubMed

34.

Barker FG II, Jannetta PJ, Bissonette DJ et al (1996) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–1083CrossRefPubMed

35.

Broggi G, Ferroli P, Franzini A et al (2000) Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 68:59–64CrossRefPubMed

36.

Apfelbaum RI (2002) Trigeminal rhizotomy. In: Burchiel KJ (ed) Surgical management of pain. Thieme Medical Publishers, New York, pp 898–902

37.

Cho D, Chang CG, Wang Y et al (1994) Repeated operation in failed microvascular decompression for trigeminal neuralgia. Neurosurgery 35:665–670CrossRefPubMed

38.

McNatt SA, Yu C, Giannotta SL et al (2005) Gamma knife radiosurgery for trigeminal neuralgia. Neurosurgery 56:1295–1301CrossRefPubMed

39.

Levi EI, Jannetta PJ (2002) Microvascular decompression. In: Burchiel KJ (ed) Surgical management of pain. Thieme, New York, pp 878–888

40.

McLaughlin MR, Jannetta PJ, Clyde BL et al (1999) Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 90:1–8CrossRefPubMed

41.

Ashkan K, Marsh H (2004) Microvascular decompression for trigeminal neuralgia in the elderly: a review of the safety and efficacy. Neurosurgery 55:840–848CrossRefPubMed

42.

Javadpour M, Eldridge PR, Varma TR et al (2003) Microvascular decompression for trigeminal neuralgia in patients over 70 years of age. Neurology 60:520PubMed

43.

Jodicke A, Winking M, Deinsberger W et al (1999) Microvascular decompression as treatment for trigeminal neuralgia in the elderly patient. Minim Invasive Neurosurg 42:92–96CrossRefPubMed

44.

Ogungbo BI, Kelly P, Kane PJ et al (2000) Microvascular decompression for trigeminal neuralgia: report of outcome in patients over 65 years of age. Br J Neurosurg 14:23–27CrossRefPubMed

45.

Ryu H, Yamamoto S, Sugiyama K et al (1999) Neurovascular decompression for trigeminal neuralgia in elderly patients. Neurol Med Chir 39:226–230CrossRef

46.

Sekula RF Jr, Marchan EM, Fletcher LH et al (2008) Microvascular decompression for trigeminal neuralgia in elderly patients. J Neurosurg 108:689–691CrossRefPubMed

Title: Advanced age as a contraindication to microvascular decompression for drug-resistant trigeminal neuralgia: evidence of prejudice?
Authors: Paolo Ferroli
Francesco Acerbi
Massimo Tomei
Giovanni Tringali
Angelo Franzini
Giovanni Broggi
Publication date: 01-02-2010
Publisher: Springer Milan
Published in: Neurological Sciences / Issue 1/2010
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-009-0156-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Advanced age as a contraindication to microvascular decompression for drug-resistant trigeminal neuralgia: evidence of prejudice?

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2010

The first case history of multiple sclerosis: Augustus d’Esté (1794–1848)

BRD2 and TAP-1 genes and juvenile myoclonic epilepsy

A case report of cranial polyneuropathy in Behcet’s disease

Familial hemifacial spasm and determinants of late onset

Spinocerebellar ataxia type 11 in the Chinese Han population

Alzheimer’s disease and endothelial dysfunction