192 Older Patients Have Greater Improvements in Pain Score Following Microvascular Decompression.

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 January 1, 2004 and December 31, 2013. Patients with typical TN and demonstrated neurovascular compression on preoperative imaging were identified and contacted to obtain information about long-term pain control using the 5-point Barrow Neurological Institute (BNI) TN pain intensity score. We divided patients into 2 groups for analysis, >age 60 and
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, whereas the >60 group had a decrease of 2.5 (P = .015, Mann-Whitney U test). 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 < .001, χ test). Multivariate regression analysis was performed and found that older age and male sex were associated with better pain score after MVD (P = .017 and P = .001, respectively), whereas V2 distribution pain was associated with worse outcome (P = .001). None of the other variables were significantly correlated with outcome.

CONCLUSION: Patients aged 60 and older had better outcomes after MVD than younger patients. These results may help to guide future patient selection.