title: Posterior fossa exploration for trigeminal neuralgia patients older than 70 years of age.
abstract: BACKGROUND
  Patients with medically unresponsive trigeminal neuralgia (TN) who are >70 years of age often undergo operations that typically provide pain relief for <5 years despite having a life expectancy that can exceed 15 years.
  
  
  OBJECTIVE
  To review the safety and efficacy of posterior fossa exploration (PFE) for TN patients > 70 years of age.
  
  
  METHODS
  From 1999 to 2009, 67 TN patients >70 years of age (median, 74 years) underwent a PFE. Thirty-seven patients (55%) had failed ≥ 1 prior surgeries (median, 2). Fifty-nine patients (88%) had a microvascular decompression, and 8 patients (12%) underwent a partial sensory rhizotomy. Follow-up (median, 40 months) was censored at the time of last contact (n = 51), additional surgery (n = 12), or death (n = 4).
  
  
  RESULTS
  Complete pain relief (no pain, no medications) was 87% at 1 year and 78% at 5 years. Facial pain outcomes did not correlate with patient age, sex, prior surgery, or pain duration. Postoperative complications were noted in 10 patients (15%) and included ataxia (10%), hearing loss (5%), trigeminal dysesthesias (5%), facial weakness (3%), aseptic meningitis (2%), and pulmonary embolus (2%). Factors associated with postoperative complications were prior PFE (P = .01) and neurovascular compression from a dolicoectatic basilar artery (P = .03).
  
  
  CONCLUSIONS
  Posterior fossa exploration is safe and effective for physiologically healthy TN patients >70 years of age. It should be deferred in older patients with TN secondary to a dolicoectatic basilar artery and patients who have persistent/recurrent pain after a previous PFE unless simpler procedures prove ineffective at controlling their facial pain.
authors: Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. pollock.bruce@mayo.edu
authors: Bruce E
authors: BE
authors: Pollock
authors: Kathy J
authors: KJ
authors: Stien
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D061145:Microvascular Decompression Surgery / Q000379:methods*; D010147:Pain Measurement; D011183:Postoperative Complications; D012189:Retrospective Studies; D019051:Rhizotomy / Q000379:methods*; D014277:Trigeminal Neuralgia / Q000601:surgery*