title: Safety of microvascular decompression for elderly patients with trigeminal neuralgia.
abstract: OBJECTIVE
  The present study compared the safety and efficacy of microvascular decompression (MVD) in groups of elderly patients and non-elderly patients with medically refractory trigeminal neuralgia (TN) and collected detailed perioperative data.
  
  
  METHODS
  Retrospective analysis of clinical data was performed in 99 patients who underwent MVD from May 2012 to June 2015. The outcome data from 27 MVD operations for 27 patients aged 70-80 years (mean 74.6 years) were compared with 72 MVD operations with 72 patients aged 25-69 years (mean 55.7 years). Preoperative comorbidities were recorded and postoperative worsening comorbidities and non-neurological complications were evaluated at discharge. Efficacy of the surgery and neurological complications were evaluated in July 2015.
  
  
  RESULTS
  No decrease in activity of daily living was found in any patient. Complete pain relief without medication was achieved in 77.8% and partial pain relief in 14.8% in the elderly group, and 83.3% and 9.7%, respectively, in the non-elderly group (p=0.750). Permanent neurological complication was not observed in the elderly group, whereas Vth nerve and VIIIth nerve complications were observed in the non-elderly group. Rates of preoperative multiple comorbidities and of cardiovascular comorbidity were significantly higher in the elderly group (p<0.01). Worsening comorbidity and new pathology at discharge were mainly hypertension in both groups, but glaucoma attack and asthma attack were observed in the elderly group. All pathologies were successfully managed.
  
  
  CONCLUSIONS
  MVD for elderly patients with TN can be achieved safely with careful perioperative management. Information of comorbidity should be shared with all staff involved in the treatment, who should work as a team to avoid worsening comorbidity. The possibility of unpredictable events in the elderly patients should always be considered.
authors.affiliation: Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan. Electronic address: amagasaki@mitsuihosp.or.jp.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Amagasaki
authors.affiliation: Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Saiko
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Naemura
authors.affiliation: Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Shono
authors.affiliation: Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakaguchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D061145:Microvascular Decompression Surgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D061214:Patient Safety; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000175:diagnosis* / Q000601:surgery*
keywords: Comorbidity; Elderly patient; Microvascular compression; Safety; Trigeminal neuralgia