Introduction: Trigeminal neuralgia (TN) is more common in elderly patients, and recent studies have demonstrated safety of microvascular decompression (MVD) in this patient population. To date age has not been shown correlated with efficacy of MVD. We evaluated the role of age in predicting outcome after MVD in patients with typical TN.
Methods: We reviewed the records of patients who underwent MVD between 1/1/2004 and 12/31/2013. Patients with typical TN and demonstrated neurovascular compression on preoperative imaging were identified and contacted in order to obtain information about long-term pain control using the five point BNI trigeminal neuralgia pain intensity score. We divided patients into two groups for analysis, >age 60 and <age 60. Other variables collected included gender, type of vascular compression, side of surgery, duration of symptoms, previous procedures, preoperative trigger points, preoperative medication responsiveness, pain distribution, and presence of hypertension.
Results: The study included 124 patients, 82 under age 60 and 42 over age 60. Average follow up was 33.8 months and was not significantly different between groups. The <60 group had average decrease in pain score of 1.9 while >60 had a decrease of 2.5 (p=0.015, Mann-Whitney U). Of patients <60, 49% had pain score of 1 or 2 (no pain, not on medications, or occasional pain, not on medications) at most recent follow up, while 79% of patients >60 had a score of 1 or 2 (p<0.001, Chi-square test). Multivariate regression analysis was performed and found that older age and male gender were associated with better pain score after MVD (p=0.017 and p=0.0037 respectively), while V2 distribution pain was associated with worse outcome (p=0.0011). None of the other variables were significantly correlated with outcome.
Conclusions: Patients aged 60 and older had better outcomes after MVD than younger patients. These results may help to guide future patient selection.
Patient Care: This study helps to further elucidate predictive factors associated with favorable outcomes following MVD. It also suggests that older patients should be considered for this effective procedure.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe preoperative factors associated with good outcome following MVD for trigeminal neuralgia
2) Discuss the relationship of age to outcome following MVD