Radiologic and Neurosurgical Diagnosis of Arterial Neurovascular Conflict on Magnetic Resonance Imaging for Trigeminal Neuralgia in Routine Clinical Practice

Singhal, Shaani; Danks, R. Andrew

doi:10.1016/j.wneu.2021.09.115

Cited by 7 publications

(5 citation statements)

References 18 publications

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“…Among them, 8 studies focused on TN[ 9 - 16 ], 2 on HFS[ 17 , 18 ], and 2 on both[ 19 , 20 ]. Three of the 12 studies were performed with 3D TOF MRA combined with 3D CISS[ 9 , 16 , 17 ], 6 with 3D TOF MRA combined with 3D FIESTA[ 10 - 13 , 18 , 19 ], 1 with 3D TOF MRA combined with 3D SPACE[ 20 ], 1 with 3D TOF MRA combined with bSSFP/FSE[ 14 ], and 1 with 3D TOF MRA combined with 3D TSE DRIVE[ 15 ]. Four of the 12 were prospective studies and the remaining 8 were retrospective studies[ 10 , 12 , 13 , 17 ].…”

Section: Resultsmentioning

confidence: 99%

“…Fewer FP can reduce the potential risk of unnecessary MVD surgery in TN or HFS patients without NVC. For these patients, alternative procedures such as balloon compression, radiofrequency lesioning, glycerol injection, or stereotactic radiotherapy are less invasive and might be preferable to MVD[ 16 ]. Likelihood ratio and DOR are composite indicators that can simultaneously reflect sensitivity and specificity.…”

Section: Discussionmentioning

confidence: 99%

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Three-dimensional time-of-flight magnetic resonance angiography combined with high resolution T2-weighted imaging in preoperative evaluation of microvascular decompression

Liang¹,

Yang²,

Zhang³

et al. 2022

World J Clin Cases

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BACKGROUND Neurovascular compression (NVC) is the main cause of primary trigeminal neuralgia (TN) and hemifacial spasm (HFS). Microvascular decompression (MVD) is an effective surgical method for the treatment of TN and HFS caused by NVC. The judgement of NVC is a critical step in the preoperative evaluation of MVD, which is related to the effect of MVD treatment. Magnetic resonance imaging (MRI) technology has been used to detect NVC prior to MVD for several years. Among many MRI sequences, three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is the most widely used. However, 3D TOF MRA has some shortcomings in detecting NVC. Therefore, 3D TOF MRA combined with high resolution T2-weighted imaging (HR T2WI) is considered to be a more effective method to detect NVC. AIM To determine the value of 3D TOF MRA combined with HR T2WI in the judgment of NVC, and thus to assess its value in the preoperative evaluation of MVD. METHODS Related studies published from inception to September 2022 based on PubMed, Embase, Web of Science, and the Cochrane Library were retrieved. Studies that investigated 3D TOF MRA combined with HR T2WI to judge NVC in patients with TN or HFS were included according to the inclusion criteria. Studies without complete data or not relevant to the research topics were excluded. The Quality Assessment of Diagnostic Accuracy Studies checklist was used to assess the quality of included studies. The publication bias of the included literature was examined by Deeks’ test. An exact binomial rendition of the bivariate mixed-effects regression model was used to synthesize data. Data analysis was performed using the MIDAS module of statistical software Stata 16.0. Two independent investigators extracted patient and study characteristics, and discrepancies were resolved by consensus. Individual and pooled sensitivities and specificities were calculated. The I² statistic and Q test were used to test heterogeneity. The study was registered on the website of PROSERO (registration No. CRD42022357158). RESULTS Our search identified 595 articles, of which 12 (including 855 patients) fulfilled the inclusion criteria. Bivariate analysis showed that the pooled sensitivity and specificity of 3D TOF MRA combined with HR T2WI for detecting NVC were 0.96 [95% confidence interval (CI): 0.92-0.98] and 0.92 (95%CI: 0.74-0.98), respectively. The pooled positive likelihood ratio was 12.4 (95%CI: 3.2-47.8), pooled negative likelihood ratio was 0.04 (95%CI: 0.02-0.09), and pooled diagnostic odds ratio was 283 (95%CI: 50-1620). The area under the receiver operating characteristic curve was 0.98 (95%CI: 0.97-0.99). The studies showed no substantial heterogeneity ( I 2 = 0, Q = 0.001 P = 0.50). CONCLUSION Our results suggest t...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Three-dimensional time-of-flight magnetic resonance angiography combined with high resolution T2-weighted imaging in preoperative evaluation of microvascular decompression

Liang¹,

Yang²,

Zhang³

et al. 2022

World J Clin Cases

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“…MRI has become a basic investigative norm for patients presenting with TN not only for detecting NVC but also for identifying further secondary pathologies. The presence of NVC was seen in 80-100% of the cases in various studies [3,5,6,8,9,[11][12][13][14][15][16]18,[20][21][22][23]. However, few studies have reported a lower incidence of NVC in the range of 50-80% [2,10,17,19].…”

Section: Discussionmentioning

confidence: 96%

“…In five studies, the risk of bias was low [2,9,12,16,21], and in the remaining 15 studies, moderate risk was present [3,5,6,8,10,11,[13][14][15][17][18][19][20]22,23] (Table 3).…”

Section: Risk Of Biasmentioning

confidence: 99%

A Systematic Review of the Role of Magnetic Resonance Imaging in the Diagnosis and Detection of Neurovascular Conflict in Patients With Trigeminal Neuralgia

Bora,

Parihar,

Raj

et al. 2023

Cureus

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Trigeminal neuralgia (TN) is a debilitating disorder causing severe, episodic, unilateral stabbing facial pain disturbing enough to disrupt the activities of daily life. Classic TN is caused due to compression injury of the trigeminal nerve at the cistern segment caused by either an artery or a vein, referred to as neurovascular contact or conflict (NVC). Magnetic resonance imaging (MRI) has been the standard tool for the diagnosis of NVC. This study aimed to determine the incidence of NVC in TN, as identified by MRI, assess the various MRI grading patterns among patients with TN, and identify the vessels primarily involved in NVC. A systematic search of studies that used MRI for the diagnosis of TN in reference to NVC was conducted on DOAJ and PubMed/PubMed Central. Data were extracted and entered into a Microsoft Excel spreadsheet. The outcomes measured were the incidence of NVC as shown in MRI, vessels involved in NVC, and MRI grading patterns. We identified and selected 20 studies that fulfilled inclusion/exclusion criteria. In total, 1,436 patients were enrolled in all included studies. The type of MRI used was 1.5 T or 3 T MRI. The mean age of the patients varied from 49 to 63 years, with an equivalent male-to-female ratio. NVC was seen in 1,276 cases out of 1,436 cases (88.85%) of TN on the ipsilateral side, as shown by MRI. The vessels involved were arteries in 80-90% of the cases, followed by veins. Among the arteries, the superior cerebellar artery was the most common artery (80-90% of cases). The grades of NVC as assessed by MRI included grades I, II, and III with varied proportions in different studies. NVC is a common problem in TN, wherein there is compression at the nerve root entry zone, and it shows a strong predilection for the elderly population. MRI seems to be a novel imaging diagnostic investigation to identify NVC associated with TN. Moreover, NVC grading must be done with MRI so that it may help the surgeon in stratifying the patient’s treatment.

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“…For 3D MIF, the selection of MR sequences for fusion also affects the final diagnostic effect. Since the combination of 3D TOF MRA and HR T2WI has several advantages in detecting NVC ( 28 , 29 ), it may add to the advantages of 3D MIF technology. In fact, this is also the most commonly used combination of MRI sequences in 3D MIF clinical studies to detect NVC ( 8 , 9 , 12-16 ).…”

Section: Discussionmentioning

confidence: 99%

3D multimodal image fusion based on MRI in the preoperative evaluation of microvascular decompression: A meta‑analysis

Liang

Yang²,

Zhang

et al. 2023

Exp Ther Med

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Neurovascular compression (NVC) is the main cause of hemifacial spasm (HFS) or trigeminal neuralgia (TN), and frequently occurs at the root entry zone of cranial nerves. Microvascular decompression (MVD) is an effective surgical treatment for TN and HFS caused by NVC. The accurate preoperative diagnosis of NVC is crucial to the evaluation of MVD as an appropriate treatment for TN and HFS. Three-dimensional (3D) time-of-flight magnetic resonance angiography (3D TOF MRA) and high resolution T2-weighted imaging (HR T2WI) are used to detect NVC prior to MVD; however, this combination alone has certain disadvantages. Multimodal image fusion (MIF) may combine two or more images from the same or different modalities, allowing neurosurgeons to use the reconstructed 3D model to observe anatomical details more clearly from different perspectives. The aim of the present meta-analysis was to evaluate the effect of 3D MIF based on 3D TOF MRA combined with HR T2WI in the preoperative diagnosis of NVC, and thus to evaluate its clinical application value in the preoperative evaluation of MVD. Relevant studies available on PubMed, Embase, Web of Science, Scopus, China National Knowledge Infrastructure and the Cochrane Library, and published from the inception of each database to September 2022, were retrieved. Studies using 3D MIF based on 3D TOF MRA combined with HR T2WI to diagnose NVC in patients with TN or HFS were included. The Quality Assessment of Diagnostic Accuracy Studies checklist was used to evaluate the quality of the included studies. The statistical software Stata 16.0 was used to perform the meta-analysis. Data extraction was performed by two independent investigators and discrepancies were resolved by discussion. Pooled sensitivities, specificities, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and the area under the receiver operating characteristic curve (AUROC) were calculated as the main summary effect size. The I² and Q-test were used to assess heterogeneity. The present search identified 702 articles, of which 7 (comprising 390 patients) fulfilled the inclusion criteria. Bivariate analysis indicated that the pooled sensitivity and specificity of 3D MIF based on 3D TOF MRA combined with HR T2WI for detecting NVC were 0.97 (95% CI, 0.95-0.99) and 0.89 (95% CI, 0.77-0.95), respectively. The pooled PLR was 8.8 (95% CI, 4.1-18.6), the pooled NLR was 0.03 (95% CI, 0.02-0.06) and the pooled DOR was 291 (95% CI, 99-853). The AUROC was 0.98 (95% CI, 0.97-0.99). The studies had no substantial heterogeneity (I 2 =0; Q=0.000; P=0.50). The present results suggested that 3D MIF based on 3D TOF MRA combined with HR T2WI had excellent sensitivity and specificity for diagnosing NVC in patients with TN or HFS. Therefore, this method should serve a key role in MVD preoperative evaluation.

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Radiologic and Neurosurgical Diagnosis of Arterial Neurovascular Conflict on Magnetic Resonance Imaging for Trigeminal Neuralgia in Routine Clinical Practice

Cited by 7 publications

References 18 publications

Three-dimensional time-of-flight magnetic resonance angiography combined with high resolution T2-weighted imaging in preoperative evaluation of microvascular decompression

Three-dimensional time-of-flight magnetic resonance angiography combined with high resolution T2-weighted imaging in preoperative evaluation of microvascular decompression

A Systematic Review of the Role of Magnetic Resonance Imaging in the Diagnosis and Detection of Neurovascular Conflict in Patients With Trigeminal Neuralgia

3D multimodal image fusion based on MRI in the preoperative evaluation of microvascular decompression: A meta‑analysis

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