高齢者三叉神経痛症例に対する微小血管減圧術

Microvascular Decompression for Trigeminal Neuralgia in Older Patients

Ⅰ．はじめに

　高齢者層の増加に伴い三叉神経痛症例も高齢化の傾向が指摘されている^{1,3,4,7,11,13,15,18)}．三叉神経痛は洗顔，食事，会話といった基本的生活動作を妨げるものであり，患者は高度のストレスに苛まれる．高齢者においては若年者に比べ，身体に対する影響は大きく，ADL（activities of daily living）に影響を与えることが予想される．治療法として服薬治療，神経ブロック^13,18)，ガンマナイフ^8,10)，微小血管減圧術が挙げられるが，手術は根本的治療法であり，ゴールドスタンダードである^2,5,9)．微小血管減圧術の良好な手術成績が多く報告されている^2,5,9)が，高齢者に焦点を置き検討した報告は比較的少ない．今回われわれは高齢者三叉神経痛例の臨床的特徴，手術における注意点などを検討したので若干の文献的考察を加え報告する．

　Microvascular decompression (MVD) is an effective form of surgery for the treatment of trigeminal neuralgia (TN), and is superior to other procedures utilized in the treatment of this condition. TN is commonly seen in the elderly, but there is debate regarding the use of MVD in elderly patients.

　This report presents a retrospective review of the clinical features and surgical outcomes in elderly patients with TN. We divided TN patients into two groups: an elderly group more than 70 years old and a younger group under 70 years old. There were no serious complications in either group, and the length of hospital stay was not influenced by the age of the patients. Surgical outcome was excellent in both groups. The surgical findings in the elderly group were atrophy of the cerebellum and segmental sclerotic changes in the affected artery.

　In cases of trigeminal neuralgia in which medical therapy has failed to produce beneficial results, we encourage elderly patients to undergo MVD if their general condition is stable. However, this procedure should be performed with great care in elderly patients to avoid the onset of complications.