Idiopathic Trigeminal Neuralgia in the Elderly

Treatment of trigeminal neuralgia (TN) in the elderly is accomplished using both medical and surgical approaches. Medical therapies are similar to those used in younger patients, but drug-drug interactions are more common in the elderly. Oxcarbazepine is one drug that has fewer side effects due to its bypassing of the cytochrome P-450 metabolic pathway. Surgical options are used for medically refractory TN; the only non-ablative procedure—microvascular decompression (MVD)—provides the most durable pain freedom but may be deferred in patients deemed to be high risk. Both outcomes and complications are similar in young and elderly patients undergoing MVD. In those deemed unsafe for MVD, ablative procedures including stereotactic radiosurgery (SRS) and various percutaneous procedures can be offered. Future studies directly comparing outcomes after MVD and SRS in the elderly with large, prospectively collected databases would help guide management strategies in elderly patients with medically refractory TN.