Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

Leal, Paulo Roberto Lacerda; Barbier, Charlotte; Hermier, M.; Souza, Miguel Angelo N.; Cristino-Filho, Gerardo; Sindou, Marc

doi:10.3171/2014.2.jns131288

Cited by 108 publications

(76 citation statements)

References 21 publications

(35 reference statements)

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“…Another recent study, by Leal and colleagues, evaluated 50 patients with unilateral idiopathic TN to determine if there is a relationship among the characteristics of symptoms, NVC, and clinical outcomes after MVD. 10 They demonstrated that greater atrophy at the trigeminal root entry zone was associated with more severe vascular compression and significantly better clinical outcome, which is consistent with our observation that atrophy in the proximal nerve near the root entry zone is associated with a trend toward better outcome. However, that study did not evaluate the nerve along its entire course but only measured the midcisternal segment.…”

Section: Discussionsupporting

confidence: 80%

“…Our data suggest that the story may be a bit more complex: Atrophy of the nerve in the cistern seems to be associated with better prognosis, possibly due to its correlation with vascular compression, but more distal atrophy (i.e., away from the site of vascular compression) might represent a poor prognosis, possibly due to intrinsic changes in the nerve. 10 As such, we have been able to distinguish 2 types of trigeminal nerve atrophy with different implications for outcome after MVD.…”

Section: Discussionmentioning

confidence: 91%

“…viduals. 4,5,7,9,10,17 In a retrospective study of 30 patients with idiopathic TN, Ha and colleagues demonstrated that, on preoperative FIESTA MRI, there was significantly more atrophy at the cisternal segment of the trigeminal nerve on the affected side than on the unaffected side compared with the affected and unaffected sides of age-and sexmatched control patients with hemifacial spasm. 5 Of note, these authors also found a significant association between the sharpness of the trigeminal-pontine angle on the affected side compared with the unaffected side, which was not found in the control group.…”

Section: Discussionmentioning

confidence: 99%

“…8,10,13,21 Structural changes in the trigeminal nerve, leading to volume loss, have been well documented, 3,6,12 and a number of studies have demonstrated that nerve atrophy ipsilateral to the symptomatic side is visible on preoperative MRI. 1,4,5,7,9,15,17 Recently, Leal et al demonstrated that atrophy in the midcisternal region of the nerve is associated with more severe vascular compression, and these patients tend to exhibit greater clinical improvement following surgical decompression of the nerve.…”

mentioning

confidence: 99%

“…1,4,5,7,9,15,17 Recently, Leal et al demonstrated that atrophy in the midcisternal region of the nerve is associated with more severe vascular compression, and these patients tend to exhibit greater clinical improvement following surgical decompression of the nerve. 10 However, it is unclear whether the nerve atrophy is entirely due to physical compaction by the compressing vessel or whether it is due, in part, to irreversible structural changes. DistinabbreviatioNs MVD = microvascular decompression; NVC = neurovascular conflict; TN = trigeminal neuralgia.…”

mentioning

confidence: 99%

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Degree of distal trigeminal nerve atrophy predicts outcome after microvascular decompression for Type 1a trigeminal neuralgia

Duan

Sweet

Munyon

et al. 2015

JNS

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obJect Trigeminal neuralgia is often associated with nerve atrophy, in addition to vascular compression. The authors evaluated whether cross-sectional areas of different portions of the trigeminal nerve on preoperative imaging could be used to predict outcome after microvascular decompression (MVD). methods A total of 26 consecutive patients with unilateral Type 1a trigeminal neuralgia underwent high-resolution fast-field echo MRI of the cerebellopontine angle followed by MVD. Preoperative images were reconstructed and reviewed by 2 examiners blinded to the side of symptoms and clinical outcome. For each nerve, a computerized automatic segmentation algorithm was used to calculate the coronal cross-sectional area at the proximal nerve near the root entry zone and the distal nerve at the exit from the porus trigeminus. Findings were correlated with outcome at 12 months. results After MVD, 17 patients were pain free and not taking medications compared with 9 with residual pain. Across all cases, the coronal cross-sectional area of the symptomatic trigeminal nerve was significantly smaller than the asymptomatic side in the proximal part of the nerve, which was correlated with degree of compression at surgery. Atrophy of the distal trigeminal nerve was more pronounced in patients who had residual pain than in those with excellent outcome. Among the 7 patients who had greater than 20% loss of nerve volume in the distal nerve, only 2 were pain free and not taking medications at long-term follow-up. coNclusioNs Trigeminal neuralgia is associated with atrophy of the root entry zone of the affected nerve compared with the asymptomatic side, but volume loss in different segments of the nerve has very different prognostic implications. Proximal atrophy is associated with vascular compression and correlates with improved outcome following MVD. However, distal atrophy is associated with a significantly worse outcome after MVD.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Degree of distal trigeminal nerve atrophy predicts outcome after microvascular decompression for Type 1a trigeminal neuralgia

Duan

Sweet

Munyon

et al. 2015

JNS

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Magnetic resonance imaging

MacDonald¹

2019

Oral and Maxillofacial Radiology

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High spatial resolution nerve‐specific DTI protocol outperforms whole‐brain DTI protocol for imaging the trigeminal nerve in healthy individuals

2020

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Diffusion tensor imaging (DTI) can provide markers of axonal micro-structure of the trigeminal nerve (cranial nerve five [CNV]), which may be affected in trigeminal neuralgia (TN) and other disorders. Previous attempts to image CNV have used low spatial resolution DTI protocols designed for whole-brain acquisition that are susceptible to errors from partial volume effects, particularly with adjacent cerebrospinal fluid (CSF). The purpose of this study was to develop a nerve-specific DTI protocol in healthy subjects that provides more accurate CNV tractography and diffusion quantification than whole-brain protocols. Four DTI protocols were compared in five healthy individuals (age 22-45 years, three males) on a 3 T Siemens Prisma MRI scanner: two newly developed nerve-specific high resolution (1.2 x 1.2 x 1.2 = 1.7 mm 3) DTI protocols without (3.5 minutes) and with CSF suppression (fluid-attenuated inversion recovery [FLAIR]; 7.5 minutes) with limited slice-coverage, and two typical whole-brain protocols with either isotropic (2 x 2 x 2 = 8 mm 3) or thicker slice anisotropic (1.9 x 1.9 x 3 = 10.8 mm 3) voxels. Deterministic tractography was used to identify the CNV and quantify bilateral fractional anisotropy (FA), and mean (MD), axial (AD) and radial diffusivity (RD). CNV volume was determined by manual tracing on T1-weighted images. High spatial resolution nerve-specific protocols yielded better delineation of CNV, with less distortions and blurring, and markedly different diffusion parameters (42% higher FA, 35% lower MD, 27% lower RD and 43% lower AD) compared with the two lower resolution whole-brain protocols. The anisotropic whole-brain protocol showed a positive correlation between CNV FA and volume. The high resolution nerve-specific protocol with FLAIR yielded additional reductions in CNV AD and MD with a value of 1.0 x 10 −3 mm 2 /s, approaching that expected for healthy young adult white matter. In conclusion, high resolution nerve-specific DTI with FLAIR enhances the identification of CNV and provides more accurate quantification of diffusion compared with lower resolution whole-brain approaches.

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Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

Cited by 108 publications

References 21 publications

Degree of distal trigeminal nerve atrophy predicts outcome after microvascular decompression for Type 1a trigeminal neuralgia

Degree of distal trigeminal nerve atrophy predicts outcome after microvascular decompression for Type 1a trigeminal neuralgia

Magnetic resonance imaging

High spatial resolution nerve‐specific DTI protocol outperforms whole‐brain DTI protocol for imaging the trigeminal nerve in healthy individuals

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