Fully Endoscopic Microvascular Decompression for Trigeminal Neuralgia in Patients Aged 85 Years and Older: A Single-Centre Case Series

The incidence of trigeminal neuralgia (TN) rises steeply with age, yet reluctance to offer posterior fossa surgery to patients aged 85 years and older persists, and no series of fully endoscopic microvascular decompression (e-MVD) confined to this group has been reported. To address this, we assessed the technical feasibility, perioperative course, and early pain outcomes of keyhole fully e-MVD in six patients aged ≥85 years with medically refractory TN treated at a single institution between May 2024 and October 2025. Procedures utilized a 3.5–4 cm retrosigmoid incision, a 1.5 cm keyhole craniotomy, a 4 mm 0° endoscope, retraction-free cerebellar relaxation, and continuous brainstem auditory evoked potential monitoring, with pain graded via the Barrow Neurological Institute (BNI) score. The median patient age was 87 years, the median operative time was 66 minutes, and estimated blood loss was minimal (0–5 mL) with zero transfusions. Preoperative BNI scores were V in five patients and IV in one; at a median follow-up of 12 months, scores improved to I in five patients and II in one (100% BNI I–II, p = 0.031) with zero recurrences. Fully endoscopic microvascular decompression is technically achievable at ≥85 years with short operative times and excellent pain relief, demonstrating that chronological age alone is an insufficient reason to withhold definitive decompression from physiologically suitable patients.