Rhizotomy resulted in the best possible outcome for a significantly greater percentage of patients who had the procedure for a second time, compared with those who had it for the first time (74% vs. 65%). Good outcomes occurred in 12% of each group. Fair outcomes occurred in 10% of the initial group and 3% of the repeat group, whereas poor outcomes occurred in 13% of the initial group and 10% of the repeat group.
The overall median time to treatment failure was similar between the first-time and repeat treatment groups (27 months vs. 19 months, respectively).
"These outcomes challenge the consensus that repeat glycerol rhizotomy has decreased pain relief and durability," Mr. Bender said. "Not only can this be used as our first-line percutaneous procedure, it can be repeated before resorting to salvage modalities."
Elderly Tolerate Decompression Less. In a third study, Dr. Anand Rughani and his colleagues at the University of Vermont, Burlington, found that elderly patients do not tolerate microvascular decompression nearly as well as younger patients, based on a higher rate of in-hospital complications and mortality in the Nationwide Inpatient Sample.
Over a 10-year period in the database, Dr. Rughani and his associates found 3,273 patients who had undergone the procedure; their median age was 57 years.
The investigators examined in-hospital outcomes in patients younger than age 65 years, those who were 65-74 years old, and those who were 75 years or older.
The risk of any in-hospital complication occurring in a patient over age 65 was 7%, compared with 10% in those over age 75, a significant difference. In-hospital mortality also significantly increased as patients aged: It was 0.13% in those younger than 65 years, 0.68% in those aged 65 years or older, and about 1.5% in those aged 85 years or older.
Other complications occurred with similar frequency in patients 65 years or older and those 75 years or older: Cardiac complications occurred at a rate of 2% in both age groups; pulmonary complications in 2% and 4%, respectively; thromboembolic complications in 1% and 2%; and stroke in 3% and 4%.
"The likelihood of discharge to a nursing home or rehabilitation facility was also robustly associated with age," Dr. Rughani said. "Unfortunately, this review only captures in-hospital complications, so delayed complications like wound infections and pulmonary embolisms might not show up. This analysis could be quite an under-representation of how older patients might respond to microvascular decompression."
None of the authors of the three studies had any financial declarations.