Use of an Artificial Neural Network for Diagnosis of Facial Pain Syndromes: An Update

McCartney, Shirley; Weltin, Markus; Burchiel, Kim J.

doi:10.1159/000353188

Cited by 21 publications

(41 citation statements)

References 42 publications

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“…9,12,13 Using the Burchiel classification of facial pain, all patients reviewed for this study had Type 1 TN, characterized by idiopathic, episodic, lancinating pain lasting several seconds, with pain-free intervals between attacks. Importantly, these patients did not have Type 2 TN, which is predominantly (> 50% of the time) aching, throbbing, or burning pain with a minor component of lancinating pain.…”

Section: Methods Study Design and Diagnostic Criteriamentioning

confidence: 99%

Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression

Ozpinar

Lee

et al. 2015

JNS

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131

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T rigeminal neuralgia (TN) is a pain syndrome characterized by severe, paroxysmal, lancinating facial pain. While many patients experience relief with carbamazepine or other drugs, many patients require surgery when their symptoms become refractory to medical therapy, or when they can no longer tolerate the medications.1 Surgical treatments such as neurectomy have targeted peripheral branches of the nerve external to the skull, and percutaneous ablative therapies have been directed at the gasserian ganglion using techniques such as radiofreabbreviatioNs BAEP = brainstem auditory evoked potential; BNI = Barrow Neurological Institute; BPI = Brief Pain Inventory; GKS = Gamma Knife surgery; HR = hazard ratio; IN = internal neurolysis; MVD = microvascular decompression; NVC = neurovascular compression; PSR = partial sensory rhizotomy; QOL = quality of life; REZ = root entry zone; RFL = radiofrequency gangliolysis; TN = trigeminal neuralgia. . Chart reviews and telephone interviews were conducted to assess patient outcomes. Pain intensity was evaluated with the Barrow Neurological Institute (BNI) Pain Intensity scale, and the Brief Pain Inventory-Facial (BPIFacial) was used to assess general and face-specific activity. Pain-free survival and durability of successful pain relief (BNI pain scores of 1 or 2) were statistically evaluated with Kaplan-Meier analysis. Prognostic factors were identified and analyzed using Cox proportional hazards regression. results A total of 177 patients with Type 1 TN were identified. A subgroup of 27 was found to have no NVC on highresolution MRI/MR angiography or at surgery. These patients were significantly younger than patients with classic Type 1 TN. Long-term follow-up was available for 26 of 27 patients, and 23 responded to the telephone survey. The median follow-up duration was 43.4 months. Immediate postoperative results were comparable to MVD, with 85% of patients pain free and 96% of patients with successful pain relief. At 1 year and 5 years, the rate of pain-free survival was 58% and 47%, respectively. Successful pain relief at those intervals was maintained in 77% and 72% of patients. Almost all patients experienced some degree of numbness or hypesthesia (96%), but in patients with successful pain relief, this numbness did not significantly impact their quality of life. There was 1 patient with a CSF leak and 1 patient with anesthesia dolorosa. Previous treatment for TN was identified as a poor prognostic factor for successful outcome. coNclusioNs This is the first report of IN with meaningful outcomes data. This study demonstrated that IN is a safe, effective, and durable treatment for TN in the absence of NVC. Pain-free outcomes with IN appeared to be more durable than radiofrequency gangliolysis, and IN appears to be more effective than stereotactic radiosurgery, 2 alternatives to posterior fossa exploration in cases of TN without NVC. Given the younger age distribution of patients in this group, consideration should be given to performing IN as an initial treatment. Accru...

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Section: Methods Study Design and Diagnostic Criteriamentioning

confidence: 99%

Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression

Ozpinar

Lee

et al. 2015

JNS

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131

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“…Diagnosis was made using clinical interview and examination. 19,23,24 Using the Burchiel 3 classification of facial pain, all patients had TN-I, characterized by idiopathic, episodic, lancinating pain lasting several seconds, with pain-free intervals between attacks. Importantly, these patients did not have what is described as TN-II, which is predominantly (> 50% of the time) aching, throbbing, or burning pain, with a minor component of lancinating pain.…”

Section: Methods Study Design and Diagnostic Criteriamentioning

confidence: 99%

Trigeminal neuralgia without neurovascular compression presents earlier than trigeminal neuralgia with neurovascular compression

Lee

Raslan

et al. 2015

JNS

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I n 1934, Dandy proposed neurovascular compression (NVC) as an etiology for trigeminal neuralgia (TN).In his series, he reported that the superior cerebellar artery caused NVC in 30.7% of patients. 6 He noted veins, tumors, and vascular and cranial malformations as other "gross findings" causing compression of the trigeminal nerve; nevertheless, in 40% of cases, he observed no evidence of a gross lesion.6 He did document, however, that his posterior fossa approach did not allow for visualization of the entire root entry zone (REZ). After years of observation, and an autopsy series that showed no NVC in cadavers without TN, 13 Jannetta advanced the hypothesis that TN was a "nerve entrapment syndrome," resulting from arteries both lengthened and rendered tortuous by arteriosclerotic cerebrovascular disease. 13 This putative mechanism accounted for recurrence Charts were reviewed, and imaging and operative data were collected for patients with and without NVC. Mean, median, and the empirical cumulative distribution of onset age were determined. Statistical analysis was performed using Student t-test, Wilcoxon and Kolmogorov-Smirnoff tests, and Kaplan-Meier analysis. Multivariate analysis was performed using a Cox proportional hazards model. results The charts of 219 patients with TN were reviewed. There were 156 patients who underwent posterior fossa exploration and microvascular decompression or internal neurolysis: 129 patients with NVC and 27 without NVC. Mean age at symptoms onset for patients with and without NVC was 51.1 and 42.6 years, respectively. This difference (8.4 years) was significant (t-test: p = 0.007), with sufficient power to detect an effect size of 8.2 years. Median age between groups with and without NVC was 53.25 and 41.2 years, respectively (p = 0.003). Histogram analysis revealed a bimodal age at onset in patients without NVC, and cumulative distribution of age at onset revealed an earlier presentation of symptoms (p = 0.003) in patients without NVC. Chi-square analysis revealed a trend toward female predominance in patients without NVC, which was not significant (p = 0.08). Multivariate analysis revealed that age at onset was related to NVC but not sex, symptom side or distribution, or patient response to medical treatment. coNclusioNs NVC is neither sufficient nor necessary for the development of TN. Patients with TN without NVC may represent a distinct population of younger, predominantly female patients. Further research into the pathophysiology underlying this debilitating disease is needed.

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“…6,39 In each case, the diagnosis of classic TN was confirmed according to the ICHD (International Classification of Headache Disorders) 25 criteria and was compliant with newer classic TN diagnostic and classification criteria. 11,28 All the patients included in the study underwent MRI examinations using the standardized protocol previously published. 22,23 Per protocol, all of these examinations included 3 high-resolution sequences centered on the trigeminal root: 3D T2-weighted driven equilibrium, 3D time-of-flight (TOF) angiography, and 3D T1-weighted sequences with gadolinium.…”

Section: Patient Selectionmentioning

confidence: 99%

Reliability of MRI for predicting characteristics of neurovascular conflicts in trigeminal neuralgia: implications for surgical decision making

Brînzeu

Drogba

Sindou

2018

Journal of Neurosurgery

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OBJECTIVEThe choice of microvascular decompression (MVD), among the several other surgical options, for treating refractory classical trigeminal neuralgia (TN) relies mostly on preoperative imaging, but the degree of reliability of MRI remains a matter of debate. The authors approached the question of predictability of neurovascular conflict (NVC) in a series of 100 protocolized MRI studies from patients with TN who underwent MVD, by reexamination of MR images, blinded to the clinical data and surgical findings, including the side of the neuralgia.METHODSPatients included in the study were those who underwent MVD after surgical indication had been determined based on a protocolized imagery workup (3D high-resolution T2-weighted cisternography centered on the trigeminal nerve, 3D time-of-flight angiography, and 3D gadolinium-enhanced T1-weighted imaging) performed at our institution. All MR images were blindly reexamined, and neurovascular relationships were described on both sides, noting the existence of compression, vessels involved, situation along the root, and degree of compression. The results of MRI evaluation were then compared with actual surgical findings. The extent of agreement and quality of the prediction were expressed with Cohen’s kappa coefficient (κ) and receiver operating characteristic (ROC) statistics.RESULTSA conflict had actually been found during surgery in 94 of 100 patients. The sensitivity of MRI to detect a conflict was 97% and the specificity was 50%. Vessel type was identified with high reliability (κ = 0.80), while the grade of the conflict and its situation along the root showed poor to average reliability (κ = 0.38 and κ = 0.40, respectively). The area under the ROC curve for predicting the presence of a conflict according to the grades of conflict seen on MRI was 0.93, which is considered very good. The positive predictive value was differentiated according to the grade of conflict, with a very high value for high grades of vascular conflict.CONCLUSIONSThis study shows an overall good reliability of MRI to predict the existence of an NVC. The prediction value is excellent for high grades of compression. Some apparent low-grade compressions on MRI may be revealed as false positives in surgical exploration. This raises the question of what other imaging methods might be used to determine not only the existence of a conflict but also its degree of compression. The degree of compression is of paramount importance to predict the probability of long-term pain relief, and therefore in the decision to propose MVD as the first choice of surgical treatment.

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Use of an Artificial Neural Network for Diagnosis of Facial Pain Syndromes: An Update

Cited by 21 publications

References 42 publications

Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression

Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression

Trigeminal neuralgia without neurovascular compression presents earlier than trigeminal neuralgia with neurovascular compression

Reliability of MRI for predicting characteristics of neurovascular conflicts in trigeminal neuralgia: implications for surgical decision making

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