Due to the alleged higher risk of complications of microvascular decompression for trigeminal neuralgia in elderly we evaluated its age-related results. A retrospective analysis of clinical outcome and complications was performed in 476 patients affected by drug-resistant trigeminal neuralgia who underwent microvascular decompression. As much as 117 patients older than 65 years (Group 1) and 359 under the age of 65 (Group 2) were followed-up for a period of 7-138 months. Pain relief was complete without medication in 84.5% in Group 1. Morbidity included slight trigeminal hypoesthesia in 5.8%; severe hearing loss in 0.9%; CSF leakage in 4.2%; transient diplopia in 3.4%; and posterior fossa subdural hematoma in 0.8% of these patients. Mortality was null. No statistically significant differences were observed between Groups 1 and 2. These findings seem to support the idea that microvascular decompression is not a dangerous surgical procedure in patients over the age of 65 years.

OBJECT Fractures of C-1 and C-2 are complex and surgical management may be difficult and challenging due to the anatomical relationship sbetween the vertebrae and neurovascular structures. The aim of this study was to evaluate the role, reliability, and accuracy of cervical fixation using the O-arm intraoperative 3D image–based navigation system. METHODS The authors evaluated patients who underwent a navigation system–based surgery for stabilization of a fracture of C-1 and/or C-2 from August 2011 to August 2013. All of the fixation screws were intraoperatively checked and their position was graded. RESULTS The patient population comprised 17 patients whose median age was 47.6 years. The surgical procedures were as follows: anterior dens screw fixation in 2 cases, transarticular fixation of C-1 and C-2 in 1 case, fixation using the Harms technique in 12 cases, and occipitocervical fixation in 2 cases. A total of 67 screws were placed. The control intraoperative CT scan revealed 62 screws (92.6%) correctly placed, 4 (5.9%) with a minor cortical violation (< 2 mm), and only 1 screw (1.5%) that was judged to be incorrectly placed and that was immediately corrected. No vascular injury of the vertebral artery was observed either during exposition or during screw placement. No implant failure was observed. CONCLUSIONS The use of a navigation system based on an intraoperative CT allows a real-time visualization of the vertebrae, reducing the risks of screw misplacement and consequent complications.

Spinal fixation and fusion in patients older than 75 years old grants good results in terms of quality of life but the rate of morbidity is higher than standard spine surgery. Rate of fusion especially is still a critical point.

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