Surgical management of trigeminal neuralgia in elderly patients using a small retrosigmoidal approach: analysis of efficacy and safety.

BACKGROUND: Trigeminal neuralgia is one of the most common causes of facial pain with the highest incidence in individuals > 60 years old. Despite the proven efficacy and safety of microvascular decompression (MVD) for the treatment of trigeminal neuralgia, some physicians are reluctant to perform the procedure in elderly patients because of potential complications. MATERIAL AND METHODS: In the present study, we analyze the outcome of MVDs performed over a 10-year period in elderly patients and compare the results with those obtained in younger patients. A total of 32% of the patients were ≥ 65 years of age at the time of diagnosis. All of the patients were treated via a small retrosigmoidal approach because of reluctance for medical treatment. Overall, 87% of the patients exhibited microvascular compression of the fifth nerve in the root entry zone and were treated using MVD; the remainder of the patients were treated using a trigeminal root compression technique when a vessel was not compressing the fifth nerve. RESULTS: After the procedure, 93% reported complete relief of pain with a recurrence rate of 10.8% over a mean time of 43 months. A total of 10% of the patients experienced severe complications related to the operation with no mortality. CONCLUSION: MVD continues to be the procedure of choice for the treatment of trigeminal neuralgia in patients reluctant to medical treatment, including elderly patients because age is not a contraindication.

Efficacy and safety of root compression of trigeminal nerve for trigeminal neuralgia without evidence of vascular compression.

OBJECTIVE: Trigeminal neuralgia (TN) surgical treatment with microvascular decompression is highly effective and safe, but for a percentage of patients who undergo this procedure, no vascular compression is found. The purpose of this study was to evaluate the long-term efficacy with trigeminal root compression of the trigeminal nerve in patients with TN refractory to medical treatment who underwent neurosurgical management by a retrosigmoid approach of the cerebellopontine angle and were found to be negative for vascular compression. METHODS: A prospective collection of clinical data on all patients with a diagnosis of idiopathic TN was conducted at our institution. A total of 277 patients with TN were treated by a keyhole retrosigmoid approach for exploration of the cerebellopontine angle between January of 2000 and August of 2010. A total of 44 patients were found to be negative for vascular compression of the trigeminal nerve; all of these patients underwent trigeminal root compression. RESULTS: We found that all patients were pain free after the procedure. There was a 27% relapse in a mean time of 10 months, but 83% of these patients were adequately controlled by medical treatment, and only 17% needed a complementary procedure for pain relief. We also found that 63% of the patients complained of a partial loss of facial sensitivity, but only 1 patient presented with a corneal ulcer. There was a 6.7% rate of significant complications. CONCLUSIONS: We concluded that trigeminal root compression is a safe and effective option for patients with primary TN without vascular compression.