BACKGROUND AND OBJECTIVES: Although microvascular decompression (MVD) is the most effective long-term treatment for trigeminal neuralgia (TN), its risks make some neurosurgeons favor ablative procedures in elderly patients, despite their limited durability and higher risk of sensory deficits, sparking debate over the optimal approach. This retrospective analysis aims to evaluate the safety and efficacy of MVD in octogenarian patients with TN compared with younger patients. METHODS: In this matched cohort analysis, a total of 280 patients were initially included, with 33 in the octogenarian group (≥80 years) and 247 in the nonoctogenarian group (<80 years). After 4:1 propensity score matching and excluding patients with previous MVD, 152 matched patients were selected for the main analysis. RESULTS: Octogenarians were more likely to have lower body mass index (25.8 kg/m 2 vs 28.1 kg/m 2 , P = .0175) and a preoperative diagnosis of arrhythmias (15.2% vs 3.4%, P = .0237) but otherwise did not have any significant differences in medical comorbidities and the nature of TN or previous treatments. The only postoperative complications higher in octogenarians was new or worsened arrhythmia (6.1% vs 0%, P = .0460). Length of stay, readmission rates, reoperation, and medical and surgical complications did not have any significant difference between age groups. Notably, octogenarians experienced similar reductions in pain postoperatively, with similar improvements in Barrow Neurological Institute pain scores as nonoctogenarians. CONCLUSION: Octogenarians undergoing MVD for TN can achieve similar pain relief and postoperative outcomes to younger patients, despite a higher incidence of arrhythmia. Age alone should not preclude patients from receiving MVD; comprehensive evaluation of comorbidities and overall health is essential. MVD remains a viable option to improve quality of life in elderly patients with TN.
Sabahi et al. (Fri,) studied this question.