The usage of microvascular decompression of root of trigeminal nerve in elderly patients suffered from trigeminal neuralgia
Abstract
Introduction: Microvascular decompression (MVD) is the method of choice for treatment of trigeminal neuralgia (TN) in cases of revealed neurovascular conflict. It is traditionally considered that this surgical technique is contraindicated for elderly patients. These patients are often offered the various destructive methods. Objective: To evaluate the efficacy and safety of MVD of the trigeminal nerve root in patients with TN older than 75 years (elderly patients). Materials and Methods: authors performed MVD in 17 elderly patients (13 women, 4 men) suffered from TN from 2012 to 2015. VAS, BNI Pain Scale and BPI-Facial were used before and after MVD to estimate the pain intensity. The surgery results were assessed using scales by Miller (2009) and by Kondo A. et al. (2012). The efficacy and the safety of surgical intervention were evaluated between the two main groups (up to 74 years and older than 75 years). Results: The conducted analysis did not reveal any statistically significant differences between the patients of two groups as well as while analyzing the efficacy and safety of MVD. The relapse of pain after MVD within follow-up period was comparable in two groups (in 17.6% in elderly patients and 18.4% in younger patients). Conclusion: MVD in patients older than 75 years was found to be a safe and effective surgery given that precise preoperative planning which includes the evaluation of physical status of patients.
About the Authors
D. A. Rzaev
ФГБУ Федеральный центр нейрохирургии
Russian Federation
Russian Federation
G. I. Moisak
ФГБУ Федеральный центр нейрохирургии; Новосибирский государственный университет
Russian Federation
Russian Federation
E. V. Amelina
ФГБУН Конструкторско-технологический институт вычислительной техники СО РАН
Russian Federation
Russian Federation
E. V. Kulikova
ФГБУ Федеральный центр нейрохирургии
Russian Federation
Russian Federation
References
1. Афанасьева Е.В., Балязин И.В. Топографо-анатомические и физические предпосылки нейроваскулярного конфликта у больных тригеминальной невралгией. Нейрохирургия. 2008. №2, 38-42.
2. Балязина Е.В. Невралгия тройничного нерва (клиника, патогенез, диагностика и лечение). М., 2013: Автореф. дисс. докт. мед. наук.
3. Гордиенко К.С. Дифференцированное микрохирургическое лечение компрессионных тригеминальных невралгий. СПб: 2004. Автореф. дисс. канд. мед. наук.
4. Леонов В.П. Логистическая регрессия в медицине и биологии. URL: http://www.biometrica.tomsk.ru/logit_1.htm http://www.biometrica.tomsk.ru/logit_9.htm
5. Устюжанцев Н.Е. Топографо-анатомическое обоснование механизмов развития невралгии тройничного нерва и ее микрохирургического лечения. Оренбург: 2010. Автореф. дисс. докт. мед. наук.
6. Barba D., Alksne J.F. Success of microvascular decompression with and without prior surgical therapy for trigeminal neuralgia. J Neurosurg. 1984 Jan; 60(1):104-7.
7. Barker F.G., Jannetta P.J., Bissonette D.J., Larkins M.V., Jho H.D. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996; 334(17): 1077-83.
8. Bederson J.B., Wilson C.B. Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg. 1989 Sep;71(3):359-67.
9. Breiman L. Random Forests. Machine Learning. 2001; 45(1):5-32.
10. Broggi A. Microvascular decompression for trigeminal neuralgia in the elderly: a review of the safety and efficacy. Neurosurgery. 04/2006; 58(4):E799.
11. Burchiel K.J., Steege T.D., Howe J.F., Loeser J.D. Comparison of percutaneous radiofrequency gangliolysis and microvascular decompression for the surgical management of tic douloureux. Neurosurgery. 1981 Aug;9(2):111-9
12. Cruccu G., Gronseth G., Alksne J., Argoff C., Brainin M., Burchiel K., Nurmikko T., Zakrzewska J.M. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008 Oct;15(10):1013-28
13. Gmther T., Gerganov V.M., Stieglitz L., Ludemann W., Samii A. Microvascular decompression for trigeminal neuralgia in the elderly: long-term treatment outcome and comparison with younger patients. Neurosurgery. 2009 Sep; 65(3):477-82; discussion 482.
14. Hosmer D.W., Lemeshow S. Applied logistic regression. 2nd ed. John Wiley & Sons, Inc. 2000. 397 pp
15. Jorns T.P., Zakrzewska J.M. Evidence-based approach to the medical management of trigeminal neuralgia. British Journal of Neurosurgery. 2007 Jun;21(3):253-61
16. Kalkanis S.N., Eskandar E.N., Carter B.S., Barker F.G. Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. 2003 Jun;52(6):1251-61; discussion 1261-2
17. Katusic S., Williams D.B., Beard C.M., Bergstralh E.J., Kurland L.T. Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences, Rochester, Minnesota, 1945-1984. Neuroepidemiology. 1991; 10(5-6):276-81
18. Kursa M.B., Rudnicki W.R. Feature Selection with the Boruta Package. Journal of Statistical Software. 2010; 36(11): 1-13
19. Ogungbo B.I., Kelly P., Kane P.J., Nath F.P. Microvascular decompression for trigeminal neuralgia:report of outcome in patients over 65 years of age. British Journal of Neurosurgery. 2000 Feb;14(1):23-7
20. Olson S., Atkinson L., Weidmann M. Microvascular decompression for trigeminal neuralgia: recurrences and complications. J Clin Neurosci. 2005; 12(7): 787-9
21. Pollock B.E., Ecker R.D. A prospective cost-effectiveness study of trigeminal neuralgia surgery. 2005 Jul-Aug;21(4):317-22
22. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Available at: URL https://www.R-project.org/. Accessed December 28, 2015.
23. Sekula R.F., Frederickson A.M., Jannetta P.J., Quigley M.R., Aziz K.M., Arnone G.D. Microvascular decompression for e lderly patients with trigeminal neuralgia: a prospective study and systematicreview with meta-analysis. J Neurosurg. 2011 Jan; 114(1):172-9.
24. Sindou M., Leston J., Decullier E., Chapuis F. Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg. 2007 Dec;107(6):1144-53
25. Sivakanthan S., Van Gompel J.J., Alikhani P., van Loveren H., Chen R., Agazzi S. Surgical Management of Trigeminal Neuralgia: Use and Cost-Effectiveness From an Analysis of the Medicare Claims Database. Neurosurgery. 2014 Sep; 75(3):220-6.
26. Tatli M., Satici O., Kanpolat Y., Sindou M. Various surgical modalities for trigeminal neuralgia:literature study of respective long-term outcomes. 2008 Mar; 150(3):243-55.
27. Tronnier VM, Rasche D, Hamer J, Kienle AL, Kunze S. Treatment of Idiopathic Trigeminal Neuralgia: Comparison of Long-term Outcome after Radiofrequency Rhizotomy and Microvascular Decompression. Neurosurgery. 2001 Jun; 48(6): 1261-7.
28. Zakrzewska J.M., McMillan R. Trigeminal neuralgia: the diagnosis and management of this excruciating and poorly understood facial pain. Postgrad Med J. 2011 Jun; 87(1028):410-6.
29. Zakrzewska J.M. Diagnosis and differential diagnosis of trigeminal neuralgia. Clin J Pain. 2002 Jan-Feb; 18(1):14-21.
Review
For citations:
Rzaev D.A., Moisak G.I., Amelina E.V., Kulikova E.V. The usage of microvascular decompression of root of trigeminal nerve in elderly patients suffered from trigeminal neuralgia. Russian journal of neurosurgery. 2016;(4):49-56. (In Russ.)
Views:
606
Email this article 