Significance of degree of neurovascular compression in surgery for trigeminal neuralgia

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The aim of this study was to identify preoperative imaging predictors of surgical success in patients with classic trigeminal neuralgia (cTN) undergoing microvascular decompression (MVD) via retrospective multivariate regression analysis.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>All included patients met criteria for cTN and underwent preoperative MRI prior to MVD. MR images were blindly graded regarding the presence and severity (i.e., mild or severe) of neurovascular compression (NVC). All patients were contacted by telephone to determine their postoperative pain status.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 79 patients were included in this study. Sixty-two patients (78.5%) were pain-free without medication following MVD. The following findings were more commonly observed with the symptomatic nerve when compared to the contralateral asymptomatic nerve: NVC (any form), arterial compression alone, NVC along the proximal trigeminal nerve, and severe NVC (p values &lt; 0.0001). The only imaging variable that was a statistically significant predictor of being pain-free without medication following MVD was severe NVC. Patients with severe NVC were 6.36 times more likely to be pain-free following MVD compared to those without severe NVC (p = 0.007).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>In patients with cTN undergoing MVD, severe NVC on preoperative MRI is a strong predictor of an excellent surgical outcome.</jats:p></jats:sec>

Exome Sequencing Implicates Impaired GABA Signaling and Neuronal Ion Transport in Trigeminal Neuralgia

“…However, asymptomatic NVC has been noted in ∼13%–85% of asymptomatic subjects ( Haines et al., 1980 ; Hamlyn, 1997a , 1997b ; Jani et al., 2019 ). Other cases of TN are related to trigeminal nerve infection (e.g., herpes zoster), trauma, demyelination (as in multiple sclerosis), or compression from a space-occupying lesion in the cerebello-pontine angle and are termed “secondary TN.” However, a significant number of TN cases lack a demonstrable cause (“idiopathic TN [iTN]”) ( Hughes et al, 2019 ; Maarbjerg et al., 2017 ), including some cases with bilateral symptoms ( Brisman, 1987 ; Pollack et al., 1988 ).…”

Internal Neurolysis (Nerve Combing) for Trigeminal Neuralgia without Neurovascular Compression

“…It has two components: first, the degree of NVC, based in the studies of Sindou 37 and Maarbjerg, 38 and the report of Hughes, who concluded that "The only imaging variable that was a statistically significant predictor of being pain-free without medication fol-lowing MVD was severe NVC." 39 The second component is the location of the MVD. The locations were divided in thirds based on the study of Peker et al, 32 who stated that the cisternal segment of the trigeminal nerve ranged from The cisternal segment extends from the root entry point to the porus trigeminus.…”

“…Patients with severe NVC were 6.36 times more likely to be pain-free following MVD when compared with those without severe NVC. 39 According to various studies published with high resolution MRI, the presence of NVC has a sensitivity of 87% to 97% and a specificity between 50% to 100% for TN. 23,35,39,40 Recently, it was reported that ultra-high field MRI enabled advanced Diffusion tensor imaging (DTI)-based tractographic reconstruction of the white matter tracts connecting the thalamus and primary somatosensory cortex.…”

“…39 According to various studies published with high resolution MRI, the presence of NVC has a sensitivity of 87% to 97% and a specificity between 50% to 100% for TN. 23,35,39,40 Recently, it was reported that ultra-high field MRI enabled advanced Diffusion tensor imaging (DTI)-based tractographic reconstruction of the white matter tracts connecting the thalamus and primary somatosensory cortex. Reduced microstructural integrity of thalamic-somatosensory tracts was found ipsilateral to the site of NVC in patients with TN, whereas no differences were observed contralateral to the site of NVC.…”

Application of diffusion tensor imaging in detecting microstructural alteration of the trigeminal nerve root in patients with classical trigeminal neuralgia without neurovascular compression

“…[1] The pathological mechanism of classical TN has been recognized by the theory that it is a kind of disease results from neurovascular compression (NVC) of the trigeminal nerve root. [9] Microvascular decompression (MVD) was exactly designed based on this etiological explanation, and has been accepted as the most e cient treatment of classical TN currently. [22] However, strong evidence suggests that there are also a cohort patients of TN without NVC (woNVC) discovered by preoperative morphological magnetic resonance imaging (MRI) and proved by surgical nding.…”