Typical trigeminal neuralgia in patients older than 65: Safety and efficacy of microvascular decompression by the retrosigmoid approach

Abstract
OBJECT: Incidence of typical trigeminal neuralgia (TN) increases with age and neurologists and neurosurgeons frequently observe patients with this disorder at the age of 65 or more. Microvascular decompression (MVD) of the trigeminal root entry zone in posterior cranial fossa is the only etiological therapy for typical TN with the highest efficacy and durability of all treatments. This procedure is associated with possible risks (cerebellar hematoma, cranial nerve injury, stroke, and death) not seen with the alternative ablative procedures. Thus, the safety of MVD in the elderly remains non definitively demonstrated. This study was conducted to determine whether MVD is a safe and effective treatment in elderly patients with TN in comparison to younger patients.
METHODS: In this retrospective study, 25 patients older than 65 (mean age 70.1 ± 3.7 years) and 32 aging <65 (mean age 51.1 ± 6.2 years) underwent MVD by key-hole retrosigmoid approach for Type 1 TN (typical) or Type 2a TN (typical chronicized) from November 2011 to November 2016. A 75 y-o patient had Type 2b TN (atypical) versus 3 nonelderly patients were excluded. Elderly and younger groups were compared in relation to outcome and complication data.
RESULTS: At a mean follow-up 23.0 ± 5.5 months, 22 old patients (88%) reported a very good outcome without necessity of any medication for pain, versus 28 (87,5%) of the younger group. Twenty elderly patients with Type 1 TN were compared with 24 younger patients with Type 1 TN, and no significant difference in outcomes was found (p > 0.05). Five elderly patients with Type 2a TN were compared with 8 younger patients with Type 2a TN, and no significant difference in outcomes was noted (p > 0.05). There was one case of CSF leak and one case of cerebellar hematoma both in the younger cohort. Mortality was zero in both groups.
CONCLUSIONS: On the basis of our experience and of the international literature, age itself seems not to represent a major contraindication against MVD for TN.

 Keywords: 
Elderly, Microvascular Decompression, Retrosigmoid approach, Trigeminal neuralgia, Tic douloureux

Endoscopic Third Ventriculostomy (ETV) versus Ventriculoperitoneal Shunt (VPS) for pediatric hydrocephalus: a meta-analysis

Background:

Using Endoscopic Third Ventriculostomy (ETV) or Ventriculoperitoneal Shunt (VPS) as standard technique of cerebrospinal fluid (CSF) diversion has been a debatable issue. To date, a meta-analysis on the best treatment for pediatric hydrocephalus is yet to be done. ETV has been reported to have successful outcomes in many studies. The objective of this meta-analysis is to know the effectiveness of ETV compared to VPS in pediatric hydrocephalus.

Methods:

This study used electronic articles published in PubMed, EBSCO, and Google Scholar from January 1990 until January 2017. Articles included were full-text observational study or randomized control trial in Bahasa or English. Surgical failure was compared for this meta-analysis. Statistical analysis was done by using Review Manager 5.

Results:

Five articles met our inclusion and exclusion criteria. The pooled risk ratio (ETV vs. VPS) of surgical failure was 0.95 [0.76, 1.19] for fixed effect model. This analysis had no or little heterogeneity (I² = 18%; X²=0.25).

Conclusion:

In one year follow up, there is no superiority between both procedures in surgical failure. Limited studies have been conducted to compare the effectiveness of ETV compared with VPS for pediatric hydrocephalus management. Further studies comparing both treatments are required to know the best management for pediatric hydrocephalus.

Keywords: ETV, VPS, pediatric hydrocephalus, meta-analysis

Surgical treatment in traumatic brain injury with critical glasgow coma scale (GCS): clinical outcome in a single center

Aims: The goal of this study was to analyze outcomes of the patients underwent surgery for traumatic brain injury (TBI) with critical Glasgow coma scale at Dr. Soetomo General Hospital Surabaya, Indonesia in term of mortality.

Methods: All cases of critical TBI patients with hemorrhage was operated (evacuation craniotomy) from January 2015 - December 2016 at Dr. Soetomo General Hospital Surabaya, Indonesia. The data were retrospectively reviewed from the medical records. Information regarding patient age, sex, diagnoses, Glasgow Coma Scale (GCS), surgery type, and the outcome after surgery was collected and analyzed.

Results: 36 samples were analyzed from the medical records of Dr. Soetomo hospital. The operation was performedfor the patients with epidural hemorrhage (EDH), subdural hemorrhage (SDH) and intracerebral hemorrhage (ICH). In the postoperative period, 83.78% (30 patients) of patients died and only 16.22% (6 patients) survived. Survived patients were followed until six months according to Glasgow Outcome Scale (GOS).As regard with the six-month evaluation of GOS, only 2 patients came out with good functional outcome (GOS Extended8), 2 patients came out with lower moderate disability (GOS Extended 5), and 2 patients with dead status (GOS Extended 1).

Conclusions: In this retrospective study, overall 83.78% (30 patients) patients not survived but 16.22% (6 patients) survived. Two patients had better functional outcome after six months postoperative. The authors conclude that TBI patients with critical GCS should manage with surgery as indicated since good functional results can be obtained in some cases. Many factors affected the good and bad condition of the patient after craniotomy.

Keywords: Critical GCS, hemorrhage evacuation craniotomy, GOS Extended