Amagasaki Kenichi, Watanabe Saiko, Naemura Kazuaki, Shono Naoyuki, Nakaguchi Hiroshi
Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan.
Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan.
Clin Neurol Neurosurg. 2016 Feb;141:77-81. doi: 10.1016/j.clineuro.2015.12.019. Epub 2015 Dec 31.
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.
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.
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.
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.
本研究比较了微血管减压术（MVD）治疗药物难治性三叉神经痛（TN）的老年患者和非老年患者的安全性和有效性，并收集了详细的围手术期数据。
对2012年5月至2015年6月接受MVD的99例患者的临床资料进行回顾性分析。将27例年龄在70 - 80岁（平均74.6岁）患者的27例MVD手术结果数据与72例年龄在25 - 69岁（平均55.7岁）患者的72例MVD手术结果数据进行比较。记录术前合并症，并在出院时评估术后合并症恶化情况和非神经并发症。2015年7月评估手术疗效和神经并发症。
所有患者日常生活活动能力均未下降。老年组77.8%的患者无需药物即可完全缓解疼痛，14.8%的患者部分缓解疼痛；非老年组分别为83.3%和9.7%（p = 0.750）。老年组未观察到永久性神经并发症，而非老年组观察到第V对脑神经和第VIII对脑神经并发症。老年组术前多种合并症和心血管合并症的发生率显著更高（p < 0.01）。两组出院时合并症恶化和新发病主要为高血压，但老年组观察到青光眼发作和哮喘发作。所有病症均得到成功处理。
对于老年TN患者，通过仔细的围手术期管理可安全实施MVD。应与参与治疗的所有工作人员共享合并症信息，他们应作为一个团队工作以避免合并症恶化。应始终考虑老年患者发生不可预测事件的可能性。
