Robert A. Mericle, M.D.
Department of Neurological Surgery
Vanderbilt University Medical Center
B-1053 Preston Research Bldg.
Nashville, TN 37232-5345
615-322-7417
http://www.mc.vanderbilt.edu/surgery/neurosrg/Staff/Mericle/mericlebio.htm
Transcript: What is the best age for a microvascular decompression or Radiofrequency lesioning?
I’ve been asked “What’s the best age for a patient to have a MVD, microvascular decompression, or an RFL, a Radiofrequency lesion?” And I have to say first of all, I don’t have any definite age cut-offs. I think that some people are much more healthy than other people regardless of what chronological age they happen to be. Some patients can be in their late 70’s or early 80’s and be very, very healthy. As healthy as a 50 year old or a 55 year old.
That being said as a general rule if you’re a very young patient who hasn’t had any surgery before generally we would recommend that the microvascular decompression be the first go to operation. And the reason why that is is because that way you don’t have any numbness generally, most the time and it’s also much more likely to give you pain relief that lasts the rest of your life. There’s about a 75-80% chance that if you have a microvascular decompression done by somebody who’s very experienced and they find a blood vessel and put a pillow around it like we do at my institution that you’ll be pain free the rest of your life and that’s many, many decades of not having to go through other procedures.
Also in general if you’re not as healthy or maybe in advanced age and you’re in your 80’s or maybe in your late 70’s or something like that or if you have medical problems, heart disease, diabetes, or other health issues then generally a RFL procedure is a better way to go because it’s very easy, it’s very quick, there’s no incision, and you go home in a couple of hours and get back to your normal routine and not have to be in the hospital for a couple of days.
So in general, I don’t have a cut-off for how old you can be. I’ve done a patient who was 94 years old, I believe, about three or four months ago and she did great with a RFL. I wouldn’t do somebody at that age with a microvascular decompression obviously.
And in a young person, generally as I said we would recommend a microvascular decompression for a young person. But also, I’ve had a patient who’s in her late 20’s who we ended up doing a RFL on and the reason why was because she had Multiple Sclerosis. Multiple Sclerosis is a different cause of trigeminal neuralgia. When you think about “What is the cause? What causes trigeminal neuralgia?” The most common cause is a blood vessel pushing on the trigeminal nerve and the best operation for that is a microvascular decompression especially if you can tolerate the surgery.
Multiple Sclerosis is probably the second most common cause of trigeminal neuralgia and if you have that a microvascular decompression is not your best option because there’s generally not a blood vessel pressing on the nerve. It’s Multiple Sclerosis. It causes a plaque on the trigeminal nerve and that triggers the trigeminal neuralgia pain. And so in those cases usually a RFL is usually the best option.