Older Patients Have Better Pain Outcomes Following Microvascular Decompression for Trigeminal Neuralgia

Abstract

Introduction: Trigeminal neuralgia (TN) is a debilitating facial pain syndrome characterized by paroxysmal attacks of pain in the distribution of the trigeminal nerve. Microvascular decompression (MVD) is a neurosurgical intervention that can be used to treat trigeminal neuralgia in patients whose symptoms remain refractory to medical management, or in whom the side effects of medication outweigh its benefits. While the safety of MVD for TN has been demonstrated in patients of all age groups, there is relative less research that demonstrates the efficacy of MVD for TN in older patients. In this study, we sought to evaluate the relationship between age and efficacy of MVD for TN in patients with a history of typical trigeminal neuralgia and who had demonstrated neurovascular compression on preoperative imaging. Methods: A retrospective case series was performed. 124 subjects with a history of typical trigeminal neuralgia were recruited who underwent microvascular decompression at MGH between January 2004 and December 2013. Patients were divided into two groups based upon age—those 60 years of age or older, and those less than 60 years of age—and their TN-related pain both pre- and post-MVD was quantified using the Barrow Neurologic Institute pain score. Results: Older patients were found to have a significantly lower pain score following MVD relative to patients in the younger group, as well as a significantly greater decrease in their TN-related pain score from pre- to post-MVD compared to patients in the younger age group. Conclusion: Microvascular decompression for trigeminal neuralgia appears to be more effective in older patients, relative to those that are less than 60 years of age. MVD should be considered for older patients with TN who are appropriate surgical candidates.