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Shang H, Chen J, Fan Y, Huang S, Wu M, Zhong X, Yi Y, Zhao H, Feng Y. Predicting the efficacy of medical therapy in patients with trigeminal neuralgia. Clin Neurol Neurosurg 2025; 254:108926. [PMID: 40319665 DOI: 10.1016/j.clineuro.2025.108926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Revised: 03/30/2025] [Accepted: 04/27/2025] [Indexed: 05/07/2025]
Abstract
BACKGROUND While MRI has proven valuable in predicting the surgical outcomes of trigeminal neuralgia (TN), studies on predicting the efficacy of medical therapy remain limited. The goal of this study was to identify MRI and clinical characteristics that could predict the efficacy of medical therapy for TN. METHOD We conducted a blinded evaluation of MRI characteristics in TN patients. Clinical data were obtained from medical records or follow-up phone calls. The relationship between MRI findings and clinical characteristics with the efficacy of medical therapy was then analyzed. RESULTS A total of 112 patients, including 44 men and 68 women, were enrolled in the study. After six months of follow-up, 35 patients (31.3 %) reported treatment failure, 30 patients (26.8 %) reported poor results, 19 patients (17.0 %) reported good results, and 28 patients (25.0 %) reported excellent results. Logistic regression analysis revealed that patients with the vertebral artery as the offending vessel were 5.625 times more likely to experience poor medical therapy efficacy (95 % confidence interval: 1.084-30.530, p = 0.040). In contrast, patients with involvement of the ophthalmic division (V1) of the trigeminal nerve were 0.416 times less likely to experience poor medical therapy efficacy (95 % CI: 0.178-0.974, p = 0.043). CONCLUSION Our study demonstrates that the vertebral artery as the offending vessel and involvement of the ophthalmic division of the TN are correlated with medical therapy efficacy. These findings may assist clinicians in providing more informed guidance when deciding between surgical and medical treatment options for TN patients.
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Affiliation(s)
- Honglin Shang
- Department of Radiology, First People's Hospital of Foshan, Foshan, Guangdong Province 528000, China; First Clinical School of Guangdong Medical University, Zhanjiang, Guangdong Province 524000, China
| | - Jingxian Chen
- Department of Radiology, First People's Hospital of Foshan, Foshan, Guangdong Province 528000, China
| | - Yuhua Fan
- First Clinical School of Guangdong Medical University, Zhanjiang, Guangdong Province 524000, China
| | - Shengqiao Huang
- Department of Radiology, First People's Hospital of Foshan, Foshan, Guangdong Province 528000, China
| | - Minghang Wu
- Department of Radiology, First People's Hospital of Foshan, Foshan, Guangdong Province 528000, China
| | - Xuguang Zhong
- Department of Functional Neurosurgery, First People's Hospital of Foshan, Foshan, Guangdong Province 528000, China
| | - Ying Yi
- Department of Radiology, First People's Hospital of Foshan, Foshan, Guangdong Province 528000, China
| | - Hai Zhao
- Department of Radiology, First People's Hospital of Foshan, Foshan, Guangdong Province 528000, China.
| | - Yanyun Feng
- Department of Radiology, First People's Hospital of Foshan, Foshan, Guangdong Province 528000, China.
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Kumar A, Kubota Y, Yokosako S, Chernov M. Radiological Characteristics of the Affected Trigeminal Nerve in Cases of Trigeminal Neuralgia Caused by Pure Venous Conflict. World Neurosurg 2025; 194:123500. [PMID: 39581467 DOI: 10.1016/j.wneu.2024.11.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 11/15/2024] [Accepted: 11/16/2024] [Indexed: 11/26/2024]
Abstract
OBJECTIVE To assess radiological characteristics that may support the clinical diagnosis of trigeminal neuralgia caused by pure venous conflict. METHODS Preoperative constructive interference in steady state images were analyzed retrospectively in 30 patients with trigeminal neuralgia caused by pure venous conflict, which was confirmed during microvascular decompression. Length, width, T2 hyperintensity, and shape of the cisternal segment of trigeminal nerve (CN V), as well as sizes of the trigeminal-pontine angle, trigeminal-petrous angle, and cerebellopontine cistern were evaluated on both sides. RESULTS On the affected side, the length of CN V was significantly shorter (mean 7.9 mm vs. 9.0 mm, P = 0.0249), whereas its width in midportion (mean 4.0 mm vs. 3.5 mm, P = 0.0022) and the size of the trigeminal-pontine angle (mean 55.3° vs. 48.8°, P = 0.0052) were significantly larger. Other evaluated characteristics did not differ significantly between affected and nonaffected sides. Statistically significant odds ratio (OR) for the association with affected side was revealed for shorter length (OR 10.5, P = 0.0319) and larger width (OR 8.8, P = 0.0487) of CN V; the presence of either of these parameters (i.e., shorter and/or thicker CN V) provided the highest discriminative value (OR 19.3, P = 0.0063). CONCLUSIONS Identification of shorter and/or thicker CN V on the affected side in patients with trigeminal neuralgia without an obvious offending vessel on magnetic resonance imaging may suggest the presence of pure venous conflict and help with decision making about microvascular decompression.
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Affiliation(s)
- Amit Kumar
- Department of Neurosciences, Bhagwan Mahavir MEDICA Superspecialty Hospital, Ranchi, Jharkhand, India; Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Yuichi Kubota
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan.
| | - Suguru Yokosako
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Mikhail Chernov
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
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Kumar A, Anwar SSM, Bilal K, Ahmed A, Samnani S, Zafar B. Frequency of trigeminal neurovascular contacts identified on 3D-fast imaging employing steady-state acquisition magnetic resonance imaging in asymptomatic adults. Surg Neurol Int 2025; 16:31. [PMID: 39926468 PMCID: PMC11799694 DOI: 10.25259/sni_1021_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Accepted: 01/09/2025] [Indexed: 02/11/2025] Open
Abstract
Background Neurovascular conflict is considered one of the main causes of Trigeminal neuralgia, and 3D fast imaging employing steady-state acquisition magnetic resonance imaging (MRI) is the diagnostic imaging of choice. However, no tool is available to confirm imaging findings as the primary cause of trigeminal neuralgia because neurovascular contact is frequently found in asymptomatic individuals, according to some literature, although very little data is available till now. Therefore, we aim to determine the frequency of trigeminal neurovascular contact, involved nerve segment, culprit vessel, and characteristics of contacts in asymptomatic individuals. Knowledge about this is very crucial so that every patient may not be labeled as having neurovascular conflict as the primary cause and can be saved from unnecessary surgeries. Methods A retrospective observational study was conducted on 105 MRI brain scans of asymptomatic individuals for trigeminal neurovascular relationships by two expert neuro-radiologists. Percentages calculated for categorical variables and for continuous variables Shapiro-Wilk test were used. The Fisher Exact test is used to assess the association between conflict and other variables. Inter-rater reliability was computed for the outcome and other variables and Cohen's kappa to evaluate the strength of agreement. All calculations were performed using STATA version 17.0. Results Out of 105 cases, neuro-vascular contact was identified in 64 cases. The most common contacting vessel was the superior cerebellar artery. The most common nerve segment involved was the cisternal segment, followed by the Root entry zone and porous trigeminus. In about 54 cases, the vessel was abutting the nerve, while in eight cases, it was compressing and, in two cases, displacing the nerve. The superior surface of the nerve was commonly involved. The inter-rater reliability between both neuroradiologists showed significant agreement. Conclusion Neurovascular contact is found in asymptomatic individuals, so just the presence of contact in symptomatic individuals on MRI should not be considered as only the cause of trigeminal neuralgia. It is important to identify nerve thinning and distortion, which are more reliable signs.
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Affiliation(s)
- Ashok Kumar
- Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan
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Filimonova E, Pashkov A, Moysak G, Martirosyan A, Rzaev J. Hippocampal Subfield Abnormalities in Patients With Primary Trigeminal Neuralgia. J Neuroimaging 2025; 35:e70026. [PMID: 39966338 DOI: 10.1111/jon.70026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 01/11/2025] [Accepted: 02/08/2025] [Indexed: 02/20/2025] Open
Abstract
BACKGROUND AND PURPOSE Primary trigeminal neuralgia (PTN) is a prevalent chronic pain disorder whose pathogenesis is not solely confined to the trigeminal system. Although substantial progress has been made in understanding the underlying mechanisms, comprehensive and consistent data concerning the involvement of the hippocampal formation in this process are lacking. The aim of this study was to evaluate structural changes in hippocampal subfields in patients with PTN. METHODS Fifty-nine individuals who were diagnosed with PTN and 28 healthy controls matched for age and sex underwent high-resolution 3 Tesla MRI. HippUnfold software was used for the segmentation of hippocampal subfields and the extraction of features. Covariance analyses were performed to analyze changes in the volume, thickness, and gyrification index of different subfields in patients with PTN compared to controls. Furthermore, the relationships between MR morphometry data and the severity of nerve root compression, as well as the intensity and duration of pain, were examined in patients with PTN. RESULTS Our analysis demonstrated a decrease in the volume of the right cornu ammonis subfield 1 (CA1)-CA3 and left CA2 hippocampal subfields in patients with PTN compared to healthy controls (adjusted p < 0.05 for all comparisons). No statistically significant associations were found between hippocampal MR morphometry data and clinical metrics. CONCLUSIONS Our results suggest the existence of bilateral structural abnormalities in the hippocampal subfields in individuals with PTN, which could contribute to the development and progression of this condition.
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Affiliation(s)
- Elena Filimonova
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia
| | - Anton Pashkov
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia
- Department of Data Collection and Processing Systems, Novosibirsk State Technical University, Novosibirsk, Russia
| | - Galina Moysak
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia
- Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
| | | | - Jamil Rzaev
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia
- Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
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González Martínez E, Mattos-Piaggio G, Santamarta Gómez D. Review of therapeutic failures of microvascular decompression in trigeminal neuralgia at a tertiary hospital. NEUROCIRUGIA (ENGLISH EDITION) 2025; 36:47-53. [PMID: 39477090 DOI: 10.1016/j.neucie.2024.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 09/25/2024] [Accepted: 09/26/2024] [Indexed: 11/11/2024]
Abstract
INTRODUCTION Microvascular decompression (MVD) is a non-ablative technique aimed at relieving pain in trigeminal neuralgia (TN) by resolving a neurovascular conflict. Despite reported high success rates, a significant percentage of patients experience therapeutic failure. METHODS Retrospective observational study of patients with suspected TN undergoing MVD was performed with the goal of identifying factors contributing to the persistence and recurrence of pain. RESULTS In the present study, 31 patients undergoing 38 MVD procedures for TN were included (7 patients underwent reoperation after the failure of the initial operation). The mean age was 58.5 years with a male predominance (58.1%). The mean duration of pain was 6.4 years, mainly affecting branches V2 and V3 (46.7%). The most frequently described neurovascular conflict was with the superior cerebellar artery (54.8%), predominantly resolved with Teflon (75.9%). In our case series, MVD achieved pain control in 80.6% of patients at one-year post-intervention and 61.3% at the end of the follow-up period. Twelve patients experienced MVD failure: 5 cases of persistent pain and 7 cases of pain recurrence. A detailed analysis of these failures identified misdiagnosis as the reason of persistent pain in 4 patients, while inadequate surgical technique could be the cause of pain recurrence in 6 patients. CONCLUSION In our study, therapeutic failures could mainly be attributed to two factors: misdiagnosis or the use of inappropriate materials. These factors should be considered when optimizing the management of DMV in patients with NT.
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Sulaiman II, Abduljabbar Omar A, Hussein Hameed S. The Impact of Microvascular Decompression on Pain Management in Trigeminal Neuralgia: Clinical Insights. Cureus 2024; 16:e75987. [PMID: 39830530 PMCID: PMC11742552 DOI: 10.7759/cureus.75987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2024] [Indexed: 01/22/2025] Open
Abstract
Background and aim Trigeminal neuralgia (TN) is a chronic disorder accompanied by recurrent severe pain affecting the face. Many medical regimens are used in the treatment of trigeminal neuralgia. Neurosurgery intervention is the best treatment option, especially with the failure of medical therapy. The aim of the study was to assess the efficacy and outcomes of microvascular decompression for the management of trigeminal neuralgia in Erbil hospitals. Methods This is a prospective clinical study done to treat patients with classical or idiopathic (only patients with neurovascular compression) trigeminal neuralgia by microvascular decompression surgery. It was carried out in Hawler Hospital for cardiac and special surgery and Par Hospital in Erbil city, Kurdistan region, Iraq, from April 2023 to February 2024 on a sample of 21 patients who were diagnosed with trigeminal neuralgia. Results The preoperative mean pain severity score of patients with TN was 8.9±1.2. The means of pain severity score at early postoperative, two weeks postoperative, two months postoperative, six months postoperative, and twelve months postoperative were 2.5, 1.8, 1.3, 0.7, and 0.4, respectively. The preoperative pain severity score of patients with TN was significantly higher and showed a significant decrease postoperatively. The mean pain severity score of patients with TN was significantly reduced twelve months postoperatively. Postoperative complications were present in 14 (66.7%) patients with TN, commonly paresthesia in nine (42.9%), and hearing symptoms in five (23.8%) patients. Conclusion The microvascular decompression is an effective and safe surgical treatment of trigeminal neuralgia.
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Li S, Chen H, Chen J, Yang X, Zhong W, Zhou H, Meng X, Liao C, Zhang W. Predicting long-term outcomes in patients with classical trigeminal neuralgia following microvascular decompression with an MRI-based radiomics nomogram: a multicentre study. Eur Radiol 2024; 34:7349-7361. [PMID: 38717486 DOI: 10.1007/s00330-024-10775-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/20/2024] [Accepted: 03/09/2024] [Indexed: 10/29/2024]
Abstract
OBJECTIVES This study aimed to develop a clinical-radiomics nomogram to predict the long-term outcomes of patients with classical trigeminal neuralgia (CTN) following microvascular decompression (MVD). MATERIALS AND METHODS This retrospective study included 455 patients with CTN who underwent MVD from three independent institutions A total of 2030 radiomics features from the cistern segment of the trigeminal nerve were extracted computationally from the three-dimensional steady-state free precession and three-dimensional time-of-flight magnetic resonance angiography sequences. Using the least absolute shrinkage and selection operator regression, 16 features were chosen to develop radiomics signatures. A clinical-radiomics nomogram was subsequently developed in the development cohort of 279 patients via multivariate Cox regression. The predictive performance and clinical application of the nomogram were assessed in an external cohort consisting of 176 patients. RESULTS Sixteen highly outcome-related radiomics features extracted from multisequence images were used to construct the radiomics model, with concordance indices (C-index) of 0.804 and 0.796 in the development and test cohorts, respectively. Additionally, a clinical-radiomics nomogram was developed by incorporating both radiomics features and clinical characteristics (i.e., pain type and degree of neurovascular compression) and yielded higher C-indices of 0.865 and 0.834 in the development and test cohorts, respectively. K‒M survival analysis indicated that the nomogram successfully stratified patients with CTN into high-risk and low-risk groups for poor outcomes (hazard ratio: 37.18, p < 0.001). CONCLUSION Our study findings indicated that the clinical-radiomics nomogram exhibited promising performance in accurately predicting long-term pain outcomes following MVD. CLINICAL RELEVANCE STATEMENT This model had the potential to aid clinicians in making well-informed decisions regarding the treatment of patients with CTN. KEY POINTS Trigeminal neuralgia recurs in about one-third of patients after undergoing MVD. The clinical-radiomics nomogram stratified patients into high- and low-risk groups for poor surgical outcomes. Using this nomogram could better inform patients of recurrence risk and allow for discussion of alternative treatments.
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Affiliation(s)
- Shuo Li
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongjin Chen
- Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jiahao Chen
- The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xiaosheng Yang
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weijie Zhong
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han Zhou
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuchen Meng
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenlong Liao
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Wenchuan Zhang
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Bora N, Parihar P, Raj N, Nunna B, Shetty ND. Role of Magnetic Resonance Imaging in the Evaluation of Trigeminal Neuralgia Using Steady-State Imaging. Cureus 2024; 16:e60071. [PMID: 38860061 PMCID: PMC11163848 DOI: 10.7759/cureus.60071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/10/2024] [Indexed: 06/12/2024] Open
Abstract
Trigeminal neuralgia (TN) poses diagnostic challenges due to its complex origins, often associated with neurovascular compression. Advanced imaging techniques, particularly magnetic resonance imaging (MRI) with the fast imaging employing steady-state acquisition (FIESTA) sequence, offer crucial insights into TN pathophysiology. This prospective cross-sectional observational study aimed to elucidate MRI's utility in diagnosing TN and correlating imaging findings with clinical manifestations and treatment outcomes. A cohort of 41 patients clinically suspected of TN underwent MRI evaluation at Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, utilizing various sequences including FIESTA. Analysis revealed a higher incidence among females, predominant unilateral presentation, and a higher prevalence of abnormal MRI findings, with neurovascular compression as the leading etiology. Correlation analysis demonstrated significant associations between facial pain localized to the trigeminal nerve distribution, triggering factors, and abnormal MRI findings. Gender distribution did not significantly influence MRI findings. Treatment outcomes favored microvascular surgery over conservative management in cases of neurovascular compression. This study underscores MRI's pivotal role, particularly FIESTA, in TN evaluation, guiding personalized treatment strategies and emphasizing the importance of integrated clinical and imaging approaches. Further research is warranted to validate these findings and explore additional imaging modalities for a deeper understanding of TN pathogenesis.
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Affiliation(s)
- Nikita Bora
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratapsingh Parihar
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishant Raj
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhagyasri Nunna
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neha D Shetty
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Vilanilam GK, Gopal N, Middlebrooks EH, Huang JF, Bhatt AA. Compressive lesions of the head and neck: Common and uncommon must-know entities. Neuroradiol J 2024; 37:164-177. [PMID: 37026517 PMCID: PMC10973822 DOI: 10.1177/19714009231166083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
There are many lesions that cause compression of nerves and vessels in the head and neck, and they can often be overlooked in the absence of adequate history or if not suspected by the radiologist. Many of these lesions require a high index of suspicion and optimal positioning for imaging. While a multimodality approach is critical in the evaluation of compressive lesions, an MRI utilizing high-resolution (heavily weighted) T2-weighted sequence is extremely useful as a starting point. In this review, we aim to discuss the radiological features of the common and uncommon compressive lesions of the head and neck which are broadly categorized into vascular, osseous, and miscellaneous etiologies.
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Affiliation(s)
- George K Vilanilam
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Neethu Gopal
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Erik H Middlebrooks
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Alok A Bhatt
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
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Meiling JB, Miller NJ, Gandhi Mehta RK. Sensory-Predominant Trigeminal Neuropathy Secondary to a Cosmetic Liquid Nitrogen Procedure. J Clin Neuromuscul Dis 2024; 25:141-142. [PMID: 38441930 DOI: 10.1097/cnd.0000000000000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- James B Meiling
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC
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Lu J, Yang B, Zhang W, Cheng H, Zeng J, Wang Y, Wei W, Liu Z. Transplantation of olfactory ensheathing cells can alleviate neuroinflammatory responses in rats with trigeminal neuralgia. Brain Res 2024; 1825:148732. [PMID: 38104922 DOI: 10.1016/j.brainres.2023.148732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/07/2023] [Accepted: 12/14/2023] [Indexed: 12/19/2023]
Abstract
Trigeminal neuralgia (TN) is a common form of facial pain, which primarily manifests as severe pain similar to facial acupuncture and electric shock. Olfactory ensheathing cells (OECs) are glial cells with high bioactivity; these cells are essential for the periodic regeneration of the olfactory nerve and have been utilized for the repair of nerve injuries. A member of the P2X receptor family, P2X7R, is an ion channel type receptor that has been confirmed to participate in various pain response processes. In this study, we transplanted OECs into trigeminal nerve-model rats with distal infraorbital nerve ligation to observe the therapeutic effect of transplanted OECs in rats. Additionally, we utilized the P2X7R-specific inhibitor brilliant blue G (BBG) to study the therapeutic mechanisms of cell transplantation. The facial mechanical pain threshold of these rats significantly increased following cell transplantation. The immunohistochemistry, immunoblotting, and RT-qPCR results demonstrated that the levels of P2X7R, (NOD)-like receptor protein-3 (NLRP3), nuclear factor-κB (NF-κB), interleukin (IL)-1β, and IL-18 in the trigeminal ganglion of rats treated with OEC transplantation or BBG treatment were significantly lower than those in the injured group without treatment. Overall, our results demonstrate that OEC transplantation can alleviate TN in rats, and it can reduce the expression of P2X7R related inflammatory factors in TN rats, reducing neuroinflammatory response in TG.
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Affiliation(s)
- Jiafeng Lu
- Department of Anatomy, Basic Medical School, Nanchang University, Nanchang 330006, China
| | - Baolin Yang
- Department of Anatomy, Basic Medical School, Nanchang University, Nanchang 330006, China
| | - Wenjun Zhang
- Rehabilitation Medicine Department, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Hui Cheng
- Department of Anatomy, Basic Medical School, Nanchang University, Nanchang 330006, China
| | - Jingnan Zeng
- Department of Anatomy, Basic Medical School, Nanchang University, Nanchang 330006, China
| | - Yuanli Wang
- Department of Anatomy, Basic Medical School, Nanchang University, Nanchang 330006, China
| | - Wei Wei
- Department of Anatomy, Basic Medical School, Nanchang University, Nanchang 330006, China
| | - Zengxu Liu
- Department of Anatomy, Basic Medical School, Nanchang University, Nanchang 330006, China.
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12
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Fabry A, Nedunchelian M, Stacoffe N, Guinebert S, Zipfel J, Krainik A, Maindet C, Kastler B, Grand S, Kastler A. Review of craniofacial pain syndromes involving the greater occipital nerve: relevant anatomy, clinical findings, and interventional management. Neuroradiology 2024; 66:161-178. [PMID: 38159141 DOI: 10.1007/s00234-023-03273-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
Craniofacial pain syndromes exhibit a high prevalence in the general population, with a subset of patients developing chronic pain that significantly impacts their quality of life and results in substantial disabilities. Anatomical and functional assessments of the greater occipital nerve (GON) have unveiled its implication in numerous craniofacial pain syndromes, notably through the trigeminal-cervical convergence complex. The pathophysiological involvement of the greater occipital nerve in craniofacial pain syndromes, coupled with its accessibility, designates it as the primary target for various interventional procedures in managing craniofacial pain syndromes. This educational review aims to describe multiple craniofacial pain syndromes, elucidate the role of GON in their pathophysiology, detail the relevant anatomy of the greater occipital nerve (including specific intervention sites), highlight the role of imaging in diagnosing craniofacial pain syndromes, and discuss various interventional procedures such as nerve infiltration, ablation, neuromodulation techniques, and surgeries. Imaging is essential in managing these patients, whether for diagnostic or therapeutic purposes. The utilization of image guidance has demonstrated an enhancement in reproducibility, as well as technical and clinical outcomes of interventional procedures. Studies have shown that interventional management of craniofacial pain is effective in treating occipital neuralgia, cervicogenic headaches, cluster headaches, trigeminal neuralgia, and chronic migraines, with a reported efficacy of 60-90% over a duration of 1-9 months. Repeated infiltrations, neuromodulation, or ablation may prove effective in selected cases. Therefore, reassessment of treatment response and efficacy during follow-up is imperative to guide further management and explore alternative treatment options. Optimal utilization of imaging, interventional techniques, and a multidisciplinary team, including radiologists, will ensure maximum benefit for these patients.
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Affiliation(s)
- Alienor Fabry
- Neuroradiology Unit, University Hospital, Grenoble, France
| | | | | | | | | | | | | | - Bruno Kastler
- Radiology Unit, Necker University Hospital, Paris, France
| | - Sylvie Grand
- Neuroradiology Unit, University Hospital, Grenoble, France
| | - Adrian Kastler
- Neuroradiology Unit, University Hospital, Grenoble, France.
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Filimonova E, Pashkov A, Moysak G, Martirosyan A, Zaitsev B, Rzaev J. Diffusion tensor imaging reveals distributed white matter abnormalities in primary trigeminal neuralgia: Tract-based spatial statistics study. Clin Neurol Neurosurg 2024; 236:108080. [PMID: 38113657 DOI: 10.1016/j.clineuro.2023.108080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Primary trigeminal neuralgia (PTN) is a prevalent chronic pain disorder whose pathogenesis is not limited to the trigeminal system. Despite the significant advances in uncovering underlying mechanisms, there is a paucity of comprehensive and consistent data regarding the role of white matter throughout the entire brain in PTN. METHODS We performed a prospective case-control study. Sixty patients with PTN and 28 age- and sex-matched healthy controls were evaluated using diffusion tensor imaging (DTI). A tract-based spatial statistical approach was performed to investigate white matter impairment in patients with PTN with several metrics, including fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD). Additionally, ROI-based analysis was performed for each white matter tract to compare FA values between groups with correction for patient age and sex. Correlations between DTI data and nerve root compression severity, as well as pain severity, were also evaluated in patients with PTN. RESULTS Our analysis demonstrated a widespread and symmetrical reduction in FA values among TN patients when compared to the control group (p < 0.05). Specifically, this FA decrease was predominantly observed in regions such as the corona radiata, internal capsule, optic radiation, and thalami, as well as structures within the posterior fossa, notably the cerebellar peduncles. No statistically significant differences were found between patients and the control group during the MD, AD and RD map analyses. ROI-based analysis did not reveal statistically significant changes in FA values in white matter tracts (p > 0.05 in all comparisons, FDR-corrected); however, there were trends towards FA value decreases in the internal capsule (p = 0.08, FDR-corrected) and inferior fronto-occipital fasciculus (p = 0.09, FDR-corrected). CONCLUSIONS Our findings indicate the presence of microstructural abnormalities in white matter among individuals with primary trigeminal neuralgia, which may potentially play a role in the development and progression of the condition.
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Affiliation(s)
- Elena Filimonova
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia; Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia.
| | - Anton Pashkov
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia; Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia; Department of Data Collection and Processing Systems, Novosibirsk State Technical University, Novosibirsk, Russia
| | - Galina Moysak
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia; Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia; Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
| | | | - Boris Zaitsev
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia
| | - Jamil Rzaev
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia; Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia; Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
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Sudhakar V, Sekula RF. Retrosigmoid microvascular decompression as a treatment for trigeminal neuralgia in a patient with osteogenesis imperfecta. Br J Neurosurg 2023; 37:1667-1669. [PMID: 34057868 DOI: 10.1080/02688697.2021.1931811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
Individuals with osteogenesis imperfecta develop pathologic bone due to genetic defects in collagen synthesis. These patients are prone to skull base abnormalities with resultant lower cranial nerve deficits, most common of which is trigeminal neuralgia. Typically, such patients are managed medically, and surgical options are not well explored for those patients, who become refractory to medication management. While microvascular decompression is often recommended for patients with classical trigeminal neuralgia, neurovascular compression by MRI, and normal skull base anatomy, ablative procedures have been described for patients with trigeminal neuralgia and osteogenesis imperfecta. MVD via a retrosigmoid approach has not been described in a patient with trigeminal neuralgia and skull base abnormalities secondary to osteogenesis imperfecta. A 23-year-old man with osteogenesis imperfecta was referred with right-sided classical trigeminal neuralgia. His trigeminal pain had become refractory to a number of medications. High-resolution MRI demonstrated compression of the trigeminal nerve by the superior cerebellar artery. Microvascular decompression of the trigeminal nerve via a retrosigmoid craniectomy was performed, and he remains pain-free 6 months after surgery. Microvascular decompression of the trigeminal nerve through a retrosigmoid approach can be an effective surgical treatment for young patients with trigeminal neuralgia secondary to osteogenesis imperfecta.
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Affiliation(s)
- Vivek Sudhakar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Raymond F Sekula
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Li S, Liao C, Cheng G, Wu Y, Zhang W. Proximal trigeminal nerve atrophy is associated with favourable outcomes and persistent facial numbness following percutaneous balloon compression for primary trigeminal neuralgia. Acta Neurochir (Wien) 2023; 165:3867-3876. [PMID: 37953302 DOI: 10.1007/s00701-023-05849-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/15/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Whether nerve atrophy can affect the prognosis of primary trigeminal neuralgia (PTN) patients undergoing percutaneous balloon compression (PBC) remains unclear. This study aimed to determine the association between nerve characteristics observed on preoperative magnetic resonance imaging (MRI) and PBC outcomes. METHODS Between January 2019 and December 2022, a cohort of 58 patients with unilateral PTN treated with PBC were analysed retrospectively and included in this study. The relationship between MRI findings, including the proximal and distal nerve cross-sectional areas (CSAs), and favourable pain outcomes (BNI Grades I-III) was analysed through Kaplan‒Meier analysis. RESULTS After a mean follow-up period of 23.8 ± 13.0 months (range, 6-50 months), 48 (82.8%) patients with PTN were pain free with or without medication. A smaller proximal CSA ratio (proximal CSA of the affected nerve/proximal CSA of the unaffected nerve) was significantly associated with favourable outcomes. The Kaplan-Meier survival analysis showed that patients with proximal nerve atrophy (proximal CSA ratio ≤ 87% after receiver operating characteristic curve analysis) had a higher estimated 4-year probability of maintaining a favourable outcome than those without nerve atrophy (94.4% vs. 30.8%, p = 0.005). In addition, patients with proximal nerve atrophy were more likely to suffer from postoperative persistent facial numbness. CONCLUSIONS Proximal nerve atrophy is correlated with both favourable outcomes and persistent facial numbness following PBC. Prospective studies are required to determine the optimal duration and pressure of balloon compression in relation to the proximal CSA ratio to achieve better pain outcomes and less facial numbness.
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Affiliation(s)
- Shuo Li
- Department of Neurosurgery, Shanghai Ninth People's Hospital, affiliated to Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, 200011, China
| | - Chenlong Liao
- Department of Neurosurgery, Shanghai Ninth People's Hospital, affiliated to Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, 200011, China
| | - Guo Cheng
- Department of Neurosurgery, Shanghai Ninth People's Hospital, affiliated to Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, 200011, China
| | - Yiwei Wu
- Department of Neurosurgery, Shanghai Ninth People's Hospital, affiliated to Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, 200011, China
| | - Wenchuan Zhang
- Department of Neurosurgery, Shanghai Ninth People's Hospital, affiliated to Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
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Guan H, Li S, Wang X. Fully endoscopic microvascular decompression for trigeminal neuralgia: technical note and early outcomes. Neurosurg Rev 2023; 46:292. [PMID: 37910277 DOI: 10.1007/s10143-023-02188-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 11/03/2023]
Abstract
Microscopic microvascular decompression (MVD) has been considered a curative and reliable method for treating classical trigeminal neuralgia (TN) for decades. Endoscopy can provide bright illumination and a panoramic view, which enhances the visualization of the posterior fossa. In view of the above advantages of endoscopy, it gradually became an option for MVD for treating TN. This study was performed to evaluate the advantages of fully endoscopic MVD for treating TN and is presented with a description of our operative technique. From January 2020 to January 2022, 95 classical TN patients underwent fully endoscopic MVD performed by the same surgeon and assistant in our department. The assistant held the endoscope, and the surgeon operated. Brain stem auditory evoked potentials (BEMPs) were routinely monitored. For every patient, the neurovascular conflict was identified, and complete decompression was achieved. The Barrow Neurological Institute (BNI) pain intensity score was used to evaluate the degree of facial pain. The intraoperative findings, postoperative outcomes, and complications were analyzed. Immediately after the operation, 93 patients (97.9%) achieved complete pain relief (BNI score of I). Two patients (2.1%) still had some pain, but it could be adequately controlled with medicine (BNI score of III). During the 12-36 months of follow-up, recurrence was found in 3 patients (3.2%), including one patient (1.1%) with a BNI score of II and 2 patients (2.1%) with a BNI score of III. Complications were found in 5 patients (5.3%), including facial numbness in 3 patients (3.2%), vertigo in one patient (1.1%), and headache in one patient (1.1%). There were no cases of mortality, stroke, hearing impairment, facial paralysis, or other complications. Fully endoscopic MVD is a safe and effective method for treating TN. It provides bright illumination and a panoramic view for surgeons to better observe neurovascular conflicts in deep areas of the cerebellopontine angle (CPA).
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Affiliation(s)
- Hongpeng Guan
- Department of Neurosurgery, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Kongjiang Road & No.1665, Shanghai, 200092, China
| | - Shiting Li
- Department of Neurosurgery, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Kongjiang Road & No.1665, Shanghai, 200092, China
| | - Xuhui Wang
- Department of Neurosurgery, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Kongjiang Road & No.1665, Shanghai, 200092, China.
- Department of Neurosurgery, Chongming Hospital Affiliated with Shanghai University of Medicine and Health Sciences, Nanmen Road & No. 25, Shanghai, 202150, China.
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Wang F, Ma A, Wu Z, Xie M, Lun P, Sun P. Development and validation of radiomics models for the prediction of diagnosis of classic trigeminal neuralgia. Front Neurosci 2023; 17:1188590. [PMID: 37877009 PMCID: PMC10591183 DOI: 10.3389/fnins.2023.1188590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/18/2023] [Indexed: 10/26/2023] Open
Abstract
The study aims to develop a magnetic resonance imaging (MRI)-based radiomics model for the diagnosis of classic trigeminal neuralgia (cTN). This study involved 350 patients with cTN and 100 control participants. MRI data were collected retrospectively for all the enrolled subjects. The symptomatic side trigeminal nerve regions of patients and both sides of the trigeminal nerve regions of control participants were manually labeled on MRI images. Radiomics features of the areas labeled were extracted. Principle component analysis (PCA) and least absolute shrinkage and selection operator (LASSO) regression were utilized as the preliminary feature reduction methods to decrease the high dimensionality of radiomics features. Machine learning methods were established, including LASSO logistic regression, support vector machine (SVM), and Adaboost methods, evaluating each model's diagnostic abilities using 10-fold cross-validation. All the models showed excellent diagnostic ability in predicting trigeminal neuralgia. A prospective study was conducted, 20 cTN patients and 20 control subjects were enrolled to validate the clinical utility of all models. Results showed that the radiomics models based on MRI can predict trigeminal neuralgia with high accuracy, which could be used as a diagnostic tool for this disorder.
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Affiliation(s)
- Fuxu Wang
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Anbang Ma
- Shanghai Xunshi Technology Co., Ltd., Shanghai, China
| | - Zeyu Wu
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingchen Xie
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peng Lun
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peng Sun
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
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Carrillo-Ruiz JD, Covaleda-Rodríguez JC, Díaz-Martínez JA, Vallejo-Estrella A, Navarro-Olvera JL, Velasco-Campos F, Armas-Salazar A, Cid-Rodríguez FX. Minimally Invasive Retrosigmoidal Parasterional Burr-Hole Approach: Technique and Neuropathic Pain Amelioration after Microvascular Decompression of the Trigeminal Nerve. Biomedicines 2023; 11:2707. [PMID: 37893080 PMCID: PMC10603898 DOI: 10.3390/biomedicines11102707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Trigeminal neuralgia, a common condition in clinical practice, often occurs due to vascular compression caused by aberrant or ectopic arterial or venous vessels. Microvascular decompression through a minimally invasive retrosigmoidal approach has shown high rates of pain control, low complication rates, and excellent therapeutic results. OBJECTIVE To describe the surgical technique and clinical outcomes in terms of pain relief after microvascular decompression of the trigeminal nerve through a minimally invasive retrosigmoidal parasterional burr-hole technique. METHODS A group of patients with trigeminal neuralgia refractory to medical management who underwent microvascular decompression were examined. The records of the patients were considered retrospectively (2016-2018), and the outcomes were considered based on the Visual Analogue Scale (VAS) and the Barrow Neurological Institute Pain Scale (BNIPS) added to a technical note of the surgical technique for a minimally invasive retrosigmoidal parasterional burr-hole. RESULTS Twenty-two patients were evaluated, and clinical assessment after surgical intervention showed a decrease in pain according to the VAS, resulting from an average preoperative state of 9.5 ± 0.37 to a postoperative condition of 1.32 ± 1.28, exhibiting statistically significant changes (p < 0.0001, d = 9.356). On the other hand, in relation to the BNIPS scale, a decrease from an average preoperative status of 4.55 ± 0.25 to a postoperative status at 12 months of 1.73 ± 0.54 was also demonstrated, showing significant changes (p < 0.0001, d = 3.960). CONCLUSION Microvascular decompression of the trigeminal nerve through a minimally invasive retrosigmoidal parasterional burr-hole is feasible and can be a safe and effective technique for the management of pain. However, further research employing larger sample sizes and longer follow-up periods is necessary.
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Affiliation(s)
- José Damián Carrillo-Ruiz
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
- Coordination of Neuroscience, Faculty of Psychology, Mexico Anahuac University, Mexico City 52786, Mexico
- Research Direction, General Hospital of Mexico, Mexico City 06720, Mexico
| | - Juan Camilo Covaleda-Rodríguez
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
- Unit of Functional Neurosurgery and Stereotactic, Olaya Polyclinic Center, Bogota 111411, Colombia
| | - José Armando Díaz-Martínez
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
- Department of Neurosurgery, Hospital Universitario “Dr. José Eleuterio González”, Monterrey 64460, Mexico
| | - Antonio Vallejo-Estrella
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
| | - José Luis Navarro-Olvera
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
| | - Francisco Velasco-Campos
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
| | - Armando Armas-Salazar
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
- Postgraduate Department, School of Higher Education in Medicine, National Polytechnic Institute, Mexico City 07360, Mexico
| | - Fátima Ximena Cid-Rodríguez
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
- Postgraduate Department, School of Higher Education in Medicine, National Polytechnic Institute, Mexico City 07360, Mexico
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Bethamcharla R, Abou-Al-Shaar H, Maarbjerg S, Chang YF, Gacka CN, Sekula RF. Percutaneous glycerol rhizolysis of the trigeminal ganglion for the treatment of idiopathic and classic trigeminal neuralgia: Outcomes and complications. Eur J Neurol 2023; 30:3307-3313. [PMID: 37422922 DOI: 10.1111/ene.15977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/23/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND AND PURPOSE Patients with idiopathic trigeminal neuralgia (TN) with absent arterial contact or venous contact only and classic TN with morphological changes of the trigeminal nerve secondary to venous compression are not routinely recommended microvascular decompression at our institution. In patients with these anatomical subtypes of TN, limited data exists describing the outcomes of percutaneous glycerol rhizolysis (PGR) of the trigeminal ganglion (TG). METHODS We performed a retrospective single-center cohort study and analyzed outcomes and complications after PGR of the TG. Clinical outcome after PGR of the TG was assessed via the Barrow Neurological Institute (BNI) Pain Scale. RESULTS Forty-five patients underwent a total of 66 PGRs of the TG. At short-term follow-up, 58 procedures (87.9%) resulted in a BNI score of I (i.e., freedom from pain without medication). At a median follow-up of 3.07 years, 18 procedures (27.3%) resulted in a BNI score of I, 12 procedures (18.1%) resulted in BNI score of IIIa, and 36 procedures (54.5%) resulted in a BNI score of IIIb-V. The median length of freedom from pain without medication was 1.5 years. Eighteen procedures (27.3%) caused hypesthesia and two (3.0%) caused paresthesias. There were no serious complications. CONCLUSION In patients with these anatomical subtypes of TN there was a high rate of short-term pain relief for the first 1-2 years and thereafter a large proportion of patients experienced pain relapse. In this patient group, PGR of the TG represents a safe procedure that is efficacious in the short term.
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Affiliation(s)
- Raviteja Bethamcharla
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stine Maarbjerg
- Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
| | - Yue-Fang Chang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Caroline N Gacka
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Raymond F Sekula
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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20
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Gupta T, Munawara R, Kaur M, Ram K, Rao A, Gupta S, Gupta SK. Central myelin-peripheral myelin junction in trigeminal, facial, and vestibulocochlear nerve: A histo-morphometric study. Ann Anat 2023; 250:152128. [PMID: 37399929 DOI: 10.1016/j.aanat.2023.152128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND The study aimed to locate the central myelin and peripheral myelin junction (CNS PNS Junction, CPJ) in trigeminal, facial and vestibulocochlear nerves. METHODS The cisternal segments of the nerves were cut from the brainstem to the proximal margin of trigeminal ganglia (trigeminal nerve) and internal acoustic meatus (facial and vestibulocochlear nerve) from cadavers. Horizontal sections of H&E stained slides were analysed and histo morphometry was performed. The CPJ was confirmed by immunohistochemistry using monoclonal myelin basic protein antibody. RESULTS The mean length of the trigeminal, facial and vestibulocochlear nerves were 13.6 ± 3.1 mm, 12.4 ± 1.9 mm and 11.5 ± 2.0 mm respectively; mean length of the centrally myelinated segment at the point of maximum convexity was 4.1 ± 1.5 mm, 3.7 ± 1.6 mm, 3.6 ± 1.4 mm respectively. Six different patterns were observed fortheCPJ.Utilizing the derived values, the CPJwas located at a distance of 18 - 48% and 17 - 61% of the total length of the nerve in all the cases in trigeminal and facial nerve respectively. In vestibulocochlear nerve, it was located at a distance of about 13 - 54% of the total length of the nerve. CONCLUSIONS The location of the CPJ in the vestibulocochlear nerve was midway between the brainstem and internal acoustic meatus which is a novel observation.For all the nerves, the CPJ was located either at or before the half way along the length of the nerve in huge majority (97%); never crossing the 60% of the nerve length.
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Affiliation(s)
- Tulika Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Rafika Munawara
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Mandeep Kaur
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Kalu Ram
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Asha Rao
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Shivani Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sunil Kumar Gupta
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Bora N, Parihar P, Raj N, Shetty N, Nunna B. A Systematic Review of the Role of Magnetic Resonance Imaging in the Diagnosis and Detection of Neurovascular Conflict in Patients With Trigeminal Neuralgia. Cureus 2023; 15:e44614. [PMID: 37799230 PMCID: PMC10547583 DOI: 10.7759/cureus.44614] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/03/2023] [Indexed: 10/07/2023] Open
Abstract
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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Affiliation(s)
- Nikita Bora
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratap Parihar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishant Raj
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neha Shetty
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhagyasri Nunna
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Arora AJ, R Kona KK, Pawar R, Jyotsna Y. Correlation of Prepontine Cisternal Space Thickness with the Severity of Neurovascular Conflict and its Role in Predicting Outcome of Medical Management in Cases of Trigeminal Neuralgia. Neurol India 2023; 71:959-963. [PMID: 37929434 DOI: 10.4103/0028-3886.388100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Trigeminal neuralgia (TN) is a debilitating disorder that presents with sudden onset of severe, unilateral, paroxysmal, and lancinating pain usually lasting for few seconds to few minutes. Aims and Objectives The main aim of our study was to correlate the prepontine cisternal space thickness, with a severity of neurovascular compression (NVC) and percentage reduction of pain (patient outcome). Materials and Methods Ours is an observational prospective study of 40 patients presenting with TN for magnetic resonance imaging in our department. Patients were followed up on medical treatment and their pain severity evaluated on their follow-up visit. Patients were divided into two groups based on prepontine cisternal space (Group A: ≤4 mm, Group B: >4 mm) and into three groups based on the percentage reduction of pain, Group 1 (0-35%), Group 2 (36-70%), and Group 3 consisted of patients with pain reduction of more than 70%. Ipsilateral prepontine cisternal space thickness was correlated with grade of NVC and percentage reduction of pain. Results Mean percentage of pain reduction in group A and group B was 34.12 and 60.68%, respectively. Approximately 23.80% of grade1 NVC were seen in group A and 76.20% in group B, while 80% of grade 3 NVC were seen in group A and only 20% were seen in group B. Conclusion There was poor response to medical treatment, in patients with narrowed prepontine cisternal space thickness with an inverse relationship between the grade of NVC and cisternal space thickness.
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Affiliation(s)
- Abhishek J Arora
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Kiran K R Kona
- Department of Radiology and Imageology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rajsree Pawar
- Department of Radiology and Imageology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Y Jyotsna
- Department of Radiology and Imageology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Nair SK, Xie ME, Ran K, Kalluri A, Kilgore C, Huang J, Lim M, Bettegowda C, Xu R. Outcomes After Microvascular Decompression for Sole Arterial Versus Venous Compression in Trigeminal Neuralgia. World Neurosurg 2023; 173:e542-e547. [PMID: 36889635 DOI: 10.1016/j.wneu.2023.02.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE In most cases of trigeminal neuralgia (TN), the trigeminal nerve is compressed by the arterial vasculature. We sought to address the gap in understanding of pain outcomes in patients with sole arterial versus sole venous compression. METHODS We retrospectively reviewed all patients undergoing microvascular decompression at our institution, identifying patients with either sole arterial or venous compression. We dichotomized patients into arterial or venous groups and obtained demographics and postoperative complications for each case. Barrow Neurological Index (BNI) pain scores were collected preoperatively, postoperatively, and at final follow-up, as well as recurrence of pain. Differences were calculated via χ2 tests t tests, and Mann-Whitney U Tests. Ordinal regression was used to account for variables known to influence TN pain. Kaplan-Meier analysis was used to determine recurrence-free survival. RESULTS Of 1044 patients, 642 (61.5%) had either sole arterial or venous compression. Of these cases, 472 showed arterial compression and 170 showed sole venous compression. Patients in the venous compression group were significantly younger (P < 0.001). Patients with sole venous compression showed worse preoperative (P = 0.04) and final follow-up (P < 0.001) pain scores. Patients with sole venous compression had significantly higher rate of pain recurrence (P = 0.02) and BNI score at pain recurrence (P = 0.04). On ordinal regression, venous compression was found to independently predict worse BNI pain scores (odds ratio, 1.66; P = 0.003). Kaplan-Meier analysis showed a significant relationship between sole venous compression and increased risk of pain recurrence (P = 0.03). CONCLUSIONS Patients with TN with sole venous compression show worse pain outcomes after microvascular decompression compared with those with only arterial compression.
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Affiliation(s)
- Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael E Xie
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathleen Ran
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anita Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Collin Kilgore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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24
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Banerjee S, Iwanaga J, Dumont AS, Tubbs RS. An unusual finding of the Porus trigeminus: Case report with histological findings. Anat Histol Embryol 2023. [DOI: 10.1111/ahe.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/14/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023]
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25
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Lee C, Choi JG, Son BC. Increase in Trigeminal Nerve Cross-Sectional Area on Immediate Postoperative MRI Predicts Favorable Outcome After Microvascular Decompression for Classical Trigeminal Neuralgia. Neurosurgery 2023; 92:283-292. [PMID: 36399422 DOI: 10.1227/neu.0000000000002190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/20/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although distortion or indentation of a trigeminal nerve due to neurovascular compression (NVC) is associated with classical trigeminal neuralgia, whether morphological change in the trigeminal nerve is relieved by eliminating NVC has not been studied. OBJECTIVE To estimate morphological change in the trigeminal nerve after microvascular decompression (MVD). METHODS Fifty patients with classical trigeminal neuralgia who underwent MVD were included. Using coronal images in both preoperative and postoperative MRI, the trigeminal nerve cross-sectional area (CSA) was measured at 4 mm anterior to the nerve entry into the pons. Clinical outcomes were assessed using the Barrow Neurological Institute Pain Intensity Scale (BNI-PS) at the patient's latest follow-up. RESULTS Forty-one patients achieved favorable outcomes without medication (BNI-PS I or II), and 9 patients had residual pain (BNI-PS ≥ 3A). The mean symptomatic trigeminal nerve CSA was increased by 51.47% after MVD in the favorable outcome group (preoperative: 4.37 ± 1.64 mm 2 vs postoperative: 6.26 ± 1.76 mm 2 , P < .01), whereas it was not significantly changed in the unfavorable outcome group (preoperative: 4.20 ± 1.19 mm 2 vs postoperative: 4.43 ± 1.24 mm 2 , P = .69). Kaplan-Meier survival analysis showed that the 3-year probability of maintaining a favorable outcome was 92.3 ± 7.4% and 56.1 ± 11.9%, for those whose symptomatic trigeminal nerve CSA was increased by over 20% and less than 20%, respectively ( P < .01). CONCLUSION Morphological changes in the trigeminal nerve due to NVC could be recovered by MVD, and increases in the trigeminal nerve CSA predicted favorable outcomes.
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Affiliation(s)
- Changik Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Gyu Choi
- Department of Neurosurgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Chul Son
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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26
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Branstetter BF, Reddy N, Patel K, Sekula R. Sagittal Angle of the Trigeminal Nerve at the Porus Trigeminus: A Novel Measurement to Distinguish Different Causes of Classic Trigeminal Neuralgia. AJNR Am J Neuroradiol 2022; 43:1460-1463. [PMID: 36109121 PMCID: PMC9575533 DOI: 10.3174/ajnr.a7634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/19/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Classic trigeminal neuralgia is a clinical syndrome of facial pain, most often attributable to vascular compression of the proximal cisternal segment of the trigeminal nerve and treatable with microvascular decompression of the nerve. Some patients, however, meet all clinical criteria for classic trigeminal neuralgia yet do not respond to microvascular decompression. Because the reasons for surgical failure are not well understood, the aim of this study was to determine if a subset of patients with classic trigeminal neuralgia could be distinguished by measuring the angle of the trigeminal nerve in the sagittal plane as the nerve traverses the porus trigeminus. MATERIALS AND METHODS We retrospectively identified patients with either classic trigeminal neuralgia (n = 300) or hemifacial spasm (n = 300) who had undergone MR imaging, including 3-plane steady-state free precession imaging. Patients with hemifacial spasm served as controls. On sagittal steady-state free precession images, we measured the angle of each trigeminal nerve as it crosses through the porus trigeminus into the Meckel cave (SATNaPT). In patients with classic trigeminal neuralgia, we separated the nerves into symptomatic and asymptomatic sides. We compared these 3 groups using the Student t test. RESULTS Control patients had a mean SATNaPT of 170° (SD, 11°) with a normal distribution. The contralateral asymptomatic nerve in patients with classic trigeminal neuralgia had the same distribution of angles. The symptomatic nerves in patients with classic trigeminal neuralgia had a bimodal distribution; 83% of patients fell into the same distribution as the asymptomatic nerves, but the other 15% had an average angle of 143° (SD, 7°). This difference was statistically significant (P < .0001). CONCLUSIONS Patients with the clinical syndrome of classic trigeminal neuralgia fell into 2 categories based on the radiologic measurement of the SATNaPT. Most patients had an anatomically normal nerve that was affected by vascular compression, but 17% of these patients had aberrant anatomy that may cause or contribute to their clinical presentation. Further study is needed to determine whether this subset of patients should receive a different surgery to better address their underlying anatomic abnormality. The SATNaPT measurement should be included in every MR imaging interpretation performed on patients with classic trigeminal neuralgia.
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Affiliation(s)
- B F Branstetter
- From the Departments of Radiology (B.F.B.)
- Otolaryngology (B.F.B.)
| | - N Reddy
- University of Pittsburgh (N.R., K.P.), Pittsburgh, Pennsylvania
| | - K Patel
- University of Pittsburgh (N.R., K.P.), Pittsburgh, Pennsylvania
| | - R Sekula
- Neurosurgery (R.S.), University of Pittsburgh School Medicine, Pittsburgh, Pennsylvania
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27
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Traylor KS, Branstetter BF. Cranial Nerve Anatomy. Neuroimaging Clin N Am 2022; 32:565-576. [PMID: 35843663 DOI: 10.1016/j.nic.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The 12 cranial nerves (CNs) all have important functions. All, except the accessory nerve, arise solely within the cranial vault. We will discuss each CN function along with its entire CN course. The modality of choice for evaluation of the CN itself is typically MRI, however, CT is very important to access the bony foramina and CN boundaries..
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Affiliation(s)
- Katie Suzanne Traylor
- Neuroradiology Division, University of Pittsburgh School of Medicine, 200 Lothrop Street, South Tower, 2nd Floor, Suite 200, Pittsburgh, PA 15213, USA.
| | - Barton F Branstetter
- Neuroradiology Division, University of Pittsburgh School of Medicine, 200 Lothrop Street, South Tower, 2nd Floor, Suite 200, Pittsburgh, PA 15213, USA
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28
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Lamani PU, Arora AJ, Kona KKR, Yarlagadda J. Correlation of Trigeminopontine Angle with Severity of Trigeminal Neuralgia due to Neurovascular Conflict over Medial Aspect of Nerve: Can We Prognosticate the Reduction in Pain in Patients on Medical Management? Indian J Radiol Imaging 2022; 32:308-313. [PMID: 36177274 PMCID: PMC9514901 DOI: 10.1055/s-0042-1753468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background
Neurovascular conflicts (NVCs) are one of the major causative factors in patients presenting with trigeminal neuralgia (TN). We found a wide range of variation in degrees of acute angle formed between medial border of trigeminal nerve and anterior border of pons in patients with TN, i.e., medial trigeminopontine angle (mTPA), and tried to find its correlation with pain severity due to NVC over the medial aspect of nerve (mNVC).
Aims and Objectives
To correlate mTPA measurement with severity of TN due to mNVC. To calculate the reduction in pain in patients kept on medical management and its correlation with mTPA.
Materials and Methods
This was a retrospective observational study conducted between May 2018 and October 2020. A total of 41 patients presenting with TN and showing corresponding NVC were included in the study. Out of the total cases with NVC, 30 cases showed NVC over the medial surface of the nerve. All the patients were evaluated on MAGNETOM Skyra 3T magnetic resonance imaging (MRI; Siemens). Using the two-line Cobb angle method, the trigeminopontine angle was calculated. Pretreatment pain intensity and posttreatment pain relief of each patients were assessed by using the numeric rating scale (NRS) with numbers from 0 to 10 (“no pain” to “worst pain imaginable”). Relevant clinical details regarding pre- and posttreatment pain score, after a standard treatment plan of 600 mg of oxcarbazepine for 2 weeks, were collected.
Results
Patients showing response of more than or equal to 50% (≥50%) are considered as “good response” and those with response of less than 50% (<50%) are considered as “poor response.” In our study with trigeminopontine angle threshold of 45 degrees, 7 out of 8 (87.5%) patients with >45° mTPA showed poor response and 15/22 (68.2%) patients with ≤45° showed good response to medical management for TN with statistical significance difference with a
p
-valve of 0.007.
Conclusion
We found a negative correlation between the mTPA and percentage pain relief in patients kept on medical management and realized that mTPA measurement could become an important tool for prognosticating pain relief for patients of TN on medical therapy; however, more evidence and multicentric studies are required for the same.
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Affiliation(s)
- Pundalik Umalappa Lamani
- Department of Radiology and Imageology, Nizam's Institute Of Medical Sciences, Hyderabad, Telangana, India
| | - Abhishek J. Arora
- Department of Radio-Diagnosis, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Kiran Kumar Reddy Kona
- Department of Radiology and Imageology, Nizam's Institute Of Medical Sciences, Hyderabad, Telangana, India
| | - Jyotsna Yarlagadda
- Department of Radiology and Imageology, Nizam's Institute Of Medical Sciences, Hyderabad, Telangana, India
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29
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Wang Z, Zhao Z, Song Z, Wang Y, Zhao Z. The application of magnetic resonance imaging (MRI) for the prediction of surgical outcomes in trigeminal neuralgia. Postgrad Med 2022; 134:480-486. [PMID: 35503235 DOI: 10.1080/00325481.2022.2067612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Trigeminal neuralgia (TN) is a severe facial pain disorder that often requires surgical treatment. Neurovascular compression (NVC) has been widely accepted as the primary cause of classical TN (cTN). Vascular compression involving the near half of the cisternal segment of trigeminal nerve was the most likely cause of patient's symptoms. And severe NVC was a strong imaging predictor of an optimal surgical outcome. Operative treatments for cTN include microvascular decompression (MVD) and various ablative procedures. However, a significant proportion of cTN patients with significant NVC fail to achieve long-term pain relief after technically successful surgery. Neuroimaging using magnetic resonance imaging (MRI) provides a noninvasive method to generate objective biomarkers of eventual response to TN surgery. This paper reviewed the progress of research on the prediction of surgical outcomes in TN with MRI.
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Affiliation(s)
- Zairan Wang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zijun Zhao
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zihan Song
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yizheng Wang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zongmao Zhao
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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30
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Freddi TDAL, Ottaiano AC, Lucio LL, Corrêa DG, Hygino da Cruz LC. The Trigemius Nerve: Anatomy and Pathology. Semin Ultrasound CT MR 2022; 43:403-413. [DOI: 10.1053/j.sult.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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31
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Chen Q, Yi DI, Perez JNJ, Liu M, Chang SD, Barad MJ, Lim M, Qian X. The Molecular Basis and Pathophysiology of Trigeminal Neuralgia. Int J Mol Sci 2022; 23:3604. [PMID: 35408959 PMCID: PMC8998776 DOI: 10.3390/ijms23073604] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023] Open
Abstract
Trigeminal neuralgia (TN) is a complex orofacial pain syndrome characterized by the paroxysmal onset of pain attacks in the trigeminal distribution. The underlying mechanism for this debilitating condition is still not clearly understood. Decades of basic and clinical evidence support the demyelination hypothesis, where demyelination along the trigeminal afferent pathway is a major driver for TN pathogenesis and pathophysiology. Such pathological demyelination can be triggered by physical compression of the trigeminal ganglion or another primary demyelinating disease, such as multiple sclerosis. Further examination of TN patients and animal models has revealed significant molecular changes, channelopathies, and electrophysiological abnormalities in the affected trigeminal nerve. Interestingly, recent electrophysiological recordings and advanced functional neuroimaging data have shed new light on the global structural changes and the altered connectivity in the central pain-related circuits in TN patients. The current article aims to review the latest findings on the pathophysiology of TN and cross-examining them with the current surgical and pharmacologic management for TN patients. Understanding the underlying biology of TN could help scientists and clinicians to identify novel targets and improve treatments for this complex, debilitating disease.
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Affiliation(s)
- QiLiang Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Dae Ik Yi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Josiah Nathan Joco Perez
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Monica Liu
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Meredith J Barad
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Xiang Qian
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
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32
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Zhao Y, Chen J, Jiang R, Xu X, Lin L, Xue Y, Duan Q. MRI features of responsible contacts in vascular compressive trigeminal neuralgia and prediction modeling. Acta Radiol 2022; 63:100-109. [PMID: 33412924 DOI: 10.1177/0284185120983971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Multiple neurovascular contacts in patients with vascular compressive trigeminal neuralgia often challenge the diagnosis of responsible contacts. PURPOSE To analyze the magnetic resonance imaging (MRI) features of responsible contacts and establish a predictive model to accurately pinpoint the responsible contacts. MATERIAL AND METHODS Sixty-seven patients with unilateral trigeminal neuralgia were enrolled. A total of 153 definite contacts (45 responsible, 108 non-responsible) were analyzed for their MRI characteristics, including neurovascular compression (NVC) grading, distance from pons to contact (Dpons-contact), vascular origin of compressing vessels, diameter of vessel (Dvessel) and trigeminal nerve (Dtrigeminal nerve) at contact. The MRI characteristics of the responsible and non-responsible contacts were compared, and their diagnostic efficiencies were further evaluated using a receiver operating characteristic (ROC) curve. The significant MRI features were incorporated into the logistics regression analysis to build a predictive model for responsible contacts. RESULTS Compared with non-responsible contacts, NVC grading and arterial compression ratio (84.44%) were significantly higher, Dpons-contact was significantly lower at responsible contacts (P < 0.001, 0.002, and 0.033, respectively). NVC grading had a highest diagnostic area under the ROC curve (AUC) of 0.742, with a sensitivity of 64.44% and specificity of 75.00%. The logistic regression model showed a higher diagnostic efficiency, with an AUC of 0.808, sensitivity of 88.89%, and specificity of 62.04%. CONCLUSION Contact degree and position are important MRI features in identifying the responsible contacts of the trigeminal neuralgia. The logistic predictive model based on Dpons-contact, NVC grading, and vascular origin can qualitatively improve the prediction of responsible contacts for radiologists.
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Affiliation(s)
- Yufei Zhao
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, PR China
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, PR China
| | - Jianhua Chen
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, PR China
- School of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - Rifeng Jiang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, PR China
- School of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - Xue Xu
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, PR China
- School of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - Lin Lin
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, PR China
- School of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - Yunjing Xue
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, PR China
- School of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - Qing Duan
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, PR China
- School of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
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33
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Xu R, Xie ME, Jackson CM. Trigeminal Neuralgia: Current Approaches and Emerging Interventions. J Pain Res 2021; 14:3437-3463. [PMID: 34764686 PMCID: PMC8572857 DOI: 10.2147/jpr.s331036] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/13/2021] [Indexed: 12/22/2022] Open
Abstract
Trigeminal neuralgia (TN) has been described in the literature as one of the most debilitating presentations of orofacial pain. This review summarizes over 150 years of collective clinical experience in the medical and surgical treatment of TN. Fundamentally, TN remains a clinical diagnosis that must be distinguished from other types of trigeminal neuropathic pain and/or facial pain associated with other neuralgias or headache syndromes. What is increasingly clear is that there is no catch-all medical or surgical intervention that is effective for all patients with trigeminal neuralgia, likely reflective of the fact that TN is likely a heterogenous group of disorders that jointly manifests in facial pain. The first-line treatment for TN remains anticonvulsant medical therapy. Patients who fail this have a range of surgical options available to them. In general, microvascular decompression is a safe and effective procedure with immediate and durable outcomes. Patients who are unable to tolerate general anesthesia or whose medical comorbidities preclude a suboccipital craniectomy may benefit from percutaneous methodologies including glycerol or radiofrequency ablation, or both. For patients with bleeding diathesis due to blood thinning medications who are ineligible for invasive procedures, or for those who are unwilling to undergo open surgical procedures, radiosurgery may be an excellent option-provided the patient understands that maximum pain relief will take on the order of months to achieve. Finally, peripheral neurectomies continue to provide an inexpensive and resource-sparing alternative to pain relief for patients in locations with limited economic and medical resources. Ultimately, elucidation of the molecular mechanisms underlying trigeminal neuralgia will pave the way for novel, more effective and less invasive therapies.
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Affiliation(s)
- Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael E Xie
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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34
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Boeddinghaus R, Whyte A. Imaging of Trigeminal Neuralgia and Other Facial Pain. Neuroimaging Clin N Am 2021; 31:485-508. [PMID: 34689929 DOI: 10.1016/j.nic.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We review and illustrate the radiology of facial pain, emphasizing trigeminal neuralgia, relevant anatomy, current classification, concepts about etiology, and the role of imaging and its influence on the choice of treatment. We discuss glossopharyngeal neuralgia, other neuropathic causes of facial pain, postinflammatory and neoplastic causes, and nociceptive (end-organ) causes of facial pain, as well as referred otalgia. Other conditions that may present with facial pain, including trigeminal autonomic cephalgias and giant cell arteritis, are reviewed briefly. We discuss the elements of a comprehensive MR imaging protocol to enable detection of these diverse causes of facial pain.
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Affiliation(s)
- Rudolf Boeddinghaus
- Perth Radiological Clinic, 127 Hamersley Road, Subiaco, Western Australia 6008, Australia; Department of Surgery, University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia.
| | - Andy Whyte
- Department of Medicine and Radiology, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Dentistry, University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia
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35
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Singhal S, Danks RA. Radiologic and Neurosurgical Diagnosis of Arterial Neurovascular Conflict on Magnetic Resonance Imaging for Trigeminal Neuralgia in Routine Clinical Practice. World Neurosurg 2021; 157:e166-e172. [PMID: 34619400 DOI: 10.1016/j.wneu.2021.09.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The most common cause of trigeminal neuralgia is neurovascular conflict, particularly arterial compression of the trigeminal nerve (ACTN). It is possible to show this condition preoperatively on fine-cut constructive interference in steady state magnetic resonance imaging (MRI), supplemented by time-of-flight magnetic resonance angiography. We have noticed significant variability in the interpretation of these studies between radiologists and the treating neurosurgeon. We have assessed the sensitivity and specificity of these 2 styles of interpretation compared with the intraoperative observations. METHODS We studied 68 patients who underwent de novo microvascular decompression from 2011 to 2018 under the care of a single neurosurgeon in Melbourne, Australia. Data was recorded prospectively in the radiology reports, operation reports, hospital admission records and neurosurgeon correspondence from the perioperative clinic reviews. In particular, the surgical interpretation of the MRI was clearly described prospectively and preoperatively in the correspondence. The presence or absence of ACTN was recorded prospectively in the operation report. These data were collated retrospectively by the first author. RESULTS Of patients, 83.8% (57/68) had clear ACTN confirmed at surgery. Radiologists detected this abnormality in 50.9% (29/57) of these patients, with a sensitivity of 50.9% and specificity of 81.8%. The operating neurosurgeon detected ACTN in 87.7% (50/57) of the positive cases with a sensitivity of 87.7% and a specificity of 72.7%. Statistical analysis showed a significant disagreement between both styles of interpretation, with a radiologic accuracy of 55.9% compared with 85.3% neurosurgically (P < 0.0001). Follow-up review of the patient's response to surgery further supported the neurosurgical diagnosis of ACTN. CONCLUSIONS There was a strong tendency for radiologists to underreport ACTN on the preoperative MRI compared with the intraoperative findings. In this series, the neurosurgeon was able to accurately detect ACTN in 88% of patients preoperatively. However, the diagnosis of absent ACTN was still associated with a false-negative rate of 46.7% when the neurosurgeon performed the interpretation. At the current standard of fine-cut constructive interference in steady state MRI in Melbourne, underdetection of ACTN remains common. Clinicians using this test need to be acutely aware of its limitations in deciding whether to proceed to microvascular decompression.
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Affiliation(s)
- Shaani Singhal
- Department of Neurosurgery, Monash Medical Centre, Melbourne, Australia.
| | - R Andrew Danks
- Department of Neurosurgery, Monash Medical Centre, Melbourne, Australia
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Willsey MS, Mossner JM, Chestek CA, Sagher O, Patil PG. Classifier Using Pontine Radial Diffusivity and Symptom Duration Accurately Predicts Recurrence of Trigeminal Neuralgia After Microvascular Decompression: A Pilot Study and Algorithm Description. Neurosurgery 2021; 89:777-783. [PMID: 34383939 DOI: 10.1093/neuros/nyab292] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Preprocedure diffusion tensor magnetic resonance imaging (MRI) may predict the response of trigeminal neuralgia (TN) patients to Gamma Knife (Elekta AB) and microvascular decompression (MVD). OBJECTIVE To test this hypothesis using pontine-segment diffusion tensor MRI radial diffusivity (RD), a known biomarker for demyelination, to predict TN recurrence following MVD. METHODS RD from the pontine segment of the trigeminal tract was extracted in a semiautomated and blinded fashion and normalized to background pontine RD. Following validation against published results, the relationship of normalized RD to symptom duration (DS) was measured. Both parameters were then introduced into machine-learning classifiers to group patient outcomes as TN remission or recurrence. Performance was evaluated in an observational study with leave-one-out cross-validation to calculate accuracy, sensitivity, specificity, and receiver operating characteristic curves. RESULTS The study population included 22 patients with TN type 1 (TN1). There was a negative correlation of normalized RD and preoperative symptom duration (P = .035, R2 = .20). When pontine-segment RD and DS were included as input variables, 2 classifiers predicted pain-free remission versus eventual recurrence with 85% accuracy, 83% sensitivity, and 86% specificity (leave-one-out cross-validation; P = .029) in a cohort of 13 patients undergoing MVD. CONCLUSION Pontine-segment RD and DS accurately predict MVD outcomes in TN1 and provide further evidence that diffusion tensor MRI contains prognostic information. Use of a classifier may allow more accurate risk stratification for neurosurgeons and patients considering MVD as a treatment for TN1. These findings provide further insight into the relationship of pontine microstructure, represented by RD, and the pathophysiology of TN.
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Affiliation(s)
- Matthew S Willsey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - James M Mossner
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Cynthia A Chestek
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA.,Department of Electrical Engineering, University of Michigan, Ann Arbor, Michigan, USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, USA.,Robotics Graduate Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Oren Sagher
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Parag G Patil
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA.,Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
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Abstract
Schwann cells are components of the peripheral nerve myelin sheath, which supports and nourishes axons. Upon injury of the trigeminal nerve, Schwann cells are activated and cause trigeminal neuralgia by engulfing the myelin sheath and secreting various neurotrophic factors. Further, Schwann cells can repair the damaged nerve and thus alleviate trigeminal neuralgia. Here, we briefly describe the development and activation of Schwann cells after nerve injury. Moreover, we expound on the occurrence, regulation, and treatment of trigeminal neuralgia; further, we point out the current research deficiencies and future research directions.
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Affiliation(s)
- Jia-Yi Liao
- Stomatology College of Nanchang University, Nanchang, China
| | - Tian-Hua Zhou
- Basic Medical School, Nanchang University, Nanchang, China
| | - Bao-Kang Chen
- First Clinical Medical College of Nanchang University, Nanchang, China
| | - Zeng-Xu Liu
- Department of Anatomy, Basic Medical School, Nanchang University, Nanchang, China
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Kao CH, Lee MH, Yang JT, Tsai YH, Lin MHC. Percutaneous Radiofrequency Rhizotomy Is Equally Effective for Trigeminal Neuralgia Patients with or without Neurovascular Compression. PAIN MEDICINE 2021; 23:807-814. [PMID: 34264315 DOI: 10.1093/pm/pnab221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Neurovascular compression (NVC) in patients with trigeminal neuralgia (TN) can be a factor of treatment outcome especially in microvascular decompression and stereotactic radiosurgery. No such effect has been reported in percutaneous radiofrequency rhizotomy (RF). This study is to investigate if NVC affects the efficacy of RF in patients with TN. METHODS We retrospectively reviewed patients with TN who received RF in our institution. Pre-treatment MRI was performed in every patient, and the presence of NVC was reviewed independently by two physicians. The patients were followed up at least for a year after the treatment. Pain severity was assessed with numerical rating scale (NRS). RESULTS Sixty-two patients were included in the study. All the patients had single-sided lesion, and 35 patients had NVC. There was no significant difference between these two groups of patients in terms of gender distribution, age, and pre-treatment pain severity. Comparable pain severity improvement was found in one-year follow-up between these two groups (NRS 7.93 ± 0.492 without compression vs. 7.57 ± 0.451 with compression, p = 0.600). No significant difference in post-treatment pain severity at one year between these two patient groups (NRS 1.37 ± 0.466 without compression vs. 1.66 ± 0.458 with compression, p = 0.667) was found. CONCLUSIONS For patients with TN treated by RF, the presence of NVC or not is not likely to affect the one-year pain control rate.
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Affiliation(s)
- Chih-Hao Kao
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Ming-Hsueh Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.,College of Medicine, Chang Gung University, Tao-Yuan 33302, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
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Ogut E, Armagan K, Barut C. Reappraisal of the types of trigeminal porus and importance in surgical applications. Surg Radiol Anat 2021; 43:1169-1178. [PMID: 33399922 DOI: 10.1007/s00276-020-02651-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/05/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The detailed information regarding the types of trigeminal porus (TP) and related surgical approach is lacking in the literature. Therefore, we performed this study to elucidate further the types of TP and the relationships with critical surgical landmarks in the skull base. METHODS The study was performed on 19 formalin-fixed cadavers of the cranial base (52.6% male, n = 10; 47.4% female, n = 9) on both sides. Calculations were made of the vertical dimension (VD), horizontal dimension (HD), and types of TP, the thickness of the TP, the HD and VD of the internal acoustic meatus, the distance between the TP-IAM, the thickness of the ossifying tissue that forms the TP, the trigeminal nerve (CN V) in both types and the distance between the CN V-VI. RESULTS The elliptical (42.1% left, 36.8% right), oval (52.6% left, 36.8% right) and slit-like (5.3% right) types of TP were detected (X2 = 11.722). The HD of the TP was, on average, 8.02 mm (female) and 9.2 mm (male) on the right side, and 8.26 mm (female) and 8.81 mm (male) on the left side. The VD of the TP was, on average, 1.99 mm (female) and 2.65 mm (male) on the right side, and 2.42 mm (female) and 2.94 mm (male) on the left side. CONCLUSIONS In our study, ellipse and slit-like types of TP are taken into account in order to plan the surgical approaches to remove or prevent the extension of tumors. A combined surgical technique is recommended to reach the TP easily without damaging the nearby surgical structures during surgery. The oval type of TP allows a wide range of movements, so it is more advantageous in skull base surgery.
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Affiliation(s)
- Eren Ogut
- Department of Anatomy, School of Medicine, Bahcesehir University, 34734, Istanbul, Turkey
| | - Kutay Armagan
- Medical Faculty Student, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Cagatay Barut
- Department of Anatomy, School of Medicine, Bahcesehir University, 34734, Istanbul, Turkey.
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Ogut E, Armagan K, Barut C. Reappraisal of the types of trigeminal porus and importance in surgical applications. Surg Radiol Anat 2021; 43:1169-1178. [DOI: https:/doi.org/10.1007/s00276-020-02651-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/05/2020] [Indexed: 07/22/2023]
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Kim SK, Fujii T, Komaki R, Kobayashi H, Okuda T, Fujii Y, Hayakumo T, Yuasa K, Takami M, Ohtani A, Saijo Y, Koma YI, Kim SR. Distant metastasis of hepatocellular carcinoma to Meckel’s cave and cranial nerves: A case report and review of literature. World J Hepatol 2021; 13:709-716. [PMID: 34239705 PMCID: PMC8239490 DOI: 10.4254/wjh.v13.i6.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/29/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Metastasis occurs as a late event in the natural history of hepatocellular carcinoma (HCC), and most patients die of liver failure attributed to the tumor supplanting the liver. Conversely, the brain is a less common metastatic site.
CASE SUMMARY We describe a rare case of hepatitis C virus-related multiple HCC metastasizing to the cavernous sinus, Meckel’s cave, and the petrous bone involving multiple cranial nerves in an 82-year-old woman. At admission imaging studies including Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (MRI) revealed multiple HCC nodules in both right and left lobes. Ultrasound guided biopsy of the left lobe revealed moderately differentiated HCC. Molecular targeted therapy with Lenvatinib (8 mg/d for 94 d, per os) and Ramucirumab (340 mg/d and 320 mg/d, two times by intravenous injection) were administered for 4 mo, resulting in progression of the disease. Three months after the start of molecular target therapy, the patient presented with symptoms of hyperalgesia of the right face and limited abduction of the right eye, indicating disturbances in the right trigeminal and abducens nerves. Brain MRI disclosed a mass involving the cavernous sinus, Meckel’s cave and the petrous bone. Contrast-enhanced MRI with gadolinium-chelated contrast medium revealed a well-defined mass with abnormal enhancement around the right cavernous sinus and the right Meckel’s cave.
CONCLUSION The diagnosis of metastatic HCC to the cavernous sinus, Meckel’s cave, and the petrous bone was made based on neurological findings and imaging studies including MRI, but not on histological examinations. Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.
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Affiliation(s)
- Soo Ki Kim
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-0801, Hyogo, Japan
| | - Takako Fujii
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-0801, Hyogo, Japan
| | - Ryouhei Komaki
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
| | - Hisato Kobayashi
- Department of Radiology, Kobe Asahi Hospital, Kobe 653-0801, Hyogo, Japan
| | - Toyokazu Okuda
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-0801, Hyogo, Japan
| | - Yumi Fujii
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-0801, Hyogo, Japan
| | - Takanobu Hayakumo
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-0801, Hyogo, Japan
| | - Kanako Yuasa
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-0801, Hyogo, Japan
| | - Masahiro Takami
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-0801, Hyogo, Japan
| | - Aya Ohtani
- Department of Pharmacy, Kobe Asahi Hospital, Kobe 653-0801, Hyogo, Japan
| | - Yuka Saijo
- Department of Pharmacy, Kobe Asahi Hospital, Kobe 653-0801, Hyogo, Japan
| | - Yu-Ichiro Koma
- Department of Pathology, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
| | - Soo Ryang Kim
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-0801, Hyogo, Japan
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Patil S, Testarelli L. Assessment of Growth Factors, Cytokines, and Cellular Markers in Saliva of Patients with Trigeminal Neuralgia. Molecules 2021; 26:molecules26102964. [PMID: 34067581 PMCID: PMC8157075 DOI: 10.3390/molecules26102964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022] Open
Abstract
We proposed to perform a comparative analysis of growth factors, cytokines, and chemokine receptors on the salivary cells in the saliva obtained from trigeminal neuralgia (TN) and normal subjects. Saliva was collected from TN and healthy subjects. Salivary cells were isolated by centrifugation. The expression of the cell surface marker was analyzed by flow cytometry. A cytometric bead array was done to measure the levels of cytokines and growth factors on the flow cytometer. Saliva from TN subjects showed lower growth factor levels of Angiopoietin-2, bFGF, HGF, SCF, TGF-α, and VEGF and higher cytokine levels of IL-1β, TNF-α, CCL2, IL-17A, IL-6, and CXCL8, as well as higher expression levels of chemokine receptors CCR1 (CD191), CR3 (CD11b), CCR2 (CD192), CXCR5 (CD185), and CCR5 (CD196) in the cells from TN saliva. A certain set of cytokines and growth factors in the saliva, as well as chemokine receptors on salivary cells, could be a useful tool in the diagnostics and prognostics of trigeminal neuralgia. Trigeminal neuralgia is one of the significant pathological conditions in the class of chronic diseases around the world. Many targeted approaches are being tried by various research groups to utilize the information of the inflammatory microenvironment to resolve the pathology of chronic TN.
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Affiliation(s)
- Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
- Correspondence:
| | - Luca Testarelli
- Department of Oral and Maxillo Facial Sciences, Sapienza University of Rome, 00185 Rome, Italy;
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Song D, Li J, Zhai Y, Yang F, Wang M, Zhao C, Wei X. Effects of Preoperative Carbamazepine Treatment on Microvascular Decompression for Classical Trigeminal Neuralgia. World Neurosurg 2021; 149:e63-e70. [PMID: 33647489 DOI: 10.1016/j.wneu.2021.02.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Carbamazepine (CBZ) is the first-line therapy for trigeminal neuralgia (TN), and microvascular decompression (MVD) is considered to be an effective surgical treatment for TN. However, the effect of preoperative CBZ treatment on MVD outcome is not clear. METHODS From 2013 to 2019, 63 patients with classical TN underwent MVD at the First Affiliated Hospital of Zhengzhou University, China. Data were collected through telephone follow-up and electronic medical records in April 2020. Short-term surgical outcome and long-term follow-up data were estimated by univariate and multivariate analysis. RESULTS Multivariate analysis indicated that preoperative CBZ treatment was not a significant predictor for short-term outcomes of MVD (P > 0.05). Multivariate analysis for the long-term outcome of MVD indicated that preoperative CBZ treatment could predict postoperative recurrence of TN (P < 0.05). CONCLUSIONS For patients with classical TN, a longer preoperative medication history of CBZ treatment had no significant effect on short-term outcome of MVD, but CBZ treatment was associated with a poor long-term outcome following MVD.
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Affiliation(s)
- Dixiang Song
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianguo Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yixuan Zhai
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fengdong Yang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Minkai Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinting Wei
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Liao Z, Zou L, Peng W, Ming B, Zhang Y, Liu G, Ma C. Improving the accuracy of pre-operative evaluation of neurovascular conflict in trigeminal neuralgia using magnetic resonance subtraction. Neuroradiology 2021; 63:295-303. [PMID: 33392731 DOI: 10.1007/s00234-020-02624-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the ability of magnetic resonance (MR) subtraction to evaluate neurovascular conflict (NVC) and to compare it with conventional MR protocols. METHODS This prospective study included 82 patients with trigeminal neuralgia who underwent microvascular decompression for NVC. All patients had a pre-operative examination using 3T MRI. The MRI protocols used comprised 3D balanced (B)-fast field echo (FFE), 3D steady-state magnetic resonance angiography (MRA), and 3D T1-FFE sequences. MR subtraction images were obtained by subtracting native images from B-FFE and steady-state MRA. NVC evaluation was performed using subtraction images (MR subtraction) and combination images (conventional MR protocols using B-FFE and T1-FFE in combination). Clinical assessment of the degree of compression, the type of compressing vessel, and the location of conflict were undertaken by two independent observers. The two methods were then compared using surgical criteria. RESULTS MR subtraction exhibited greater accuracy than the conventional method in terms of the estimated severity of conflict (87.80% vs. 57.32%, p < 0.05), and demonstrated better consistency with surgical findings (k = 0.794 vs. k = 0.365, p < 0.05). For the type of compressing vessel and the location of conflict, both methods were highly accurate and agreed to a similar extent with surgical findings (p = 0.987, compressing vessel; p = 0.665, location of conflict). CONCLUSION MR subtraction proved reliable in NVC pre-operative evaluation, with increased accuracy when estimating severity. This result strongly supports the wider use of MR subtraction as the preferred choice in clinical application.
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Affiliation(s)
- Zhenhong Liao
- Department of Radiology, People's Hospital of Deyang City, 173 Taishan North Road, Jingyang District, Deyang City, Sichuan Province, China
| | - Linbo Zou
- Department of Neurosurgery, People's Hospital of Deyang City, 173 Taishan North Road, Jingyang District, Deyang City, Sichuan Province, China
| | - Wei Peng
- Department of Radiology, People's Hospital of Deyang City, 173 Taishan North Road, Jingyang District, Deyang City, Sichuan Province, China
| | - Bing Ming
- Department of Radiology, People's Hospital of Deyang City, 173 Taishan North Road, Jingyang District, Deyang City, Sichuan Province, China
| | - Yong Zhang
- Department of Radiology, People's Hospital of Deyang City, 173 Taishan North Road, Jingyang District, Deyang City, Sichuan Province, China
| | - Gaoyuan Liu
- Department of Radiology, People's Hospital of Deyang City, 173 Taishan North Road, Jingyang District, Deyang City, Sichuan Province, China
| | - Chun Ma
- Department of Radiology, People's Hospital of Deyang City, 173 Taishan North Road, Jingyang District, Deyang City, Sichuan Province, China.
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Rutland JW, Huang KH, Gill CM, Villavisanis DF, Alper J, Verma G, Bederson JB, Delman BN, Shrivastava RK, Balchandani P. First application of 7-T ultra-high field diffusion tensor imaging to detect altered microstructure of thalamic-somatosensory anatomy in trigeminal neuralgia. J Neurosurg 2020; 133:839-847. [PMID: 31470412 PMCID: PMC7325446 DOI: 10.3171/2019.6.jns19541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/06/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is a debilitating neurological disease that commonly results from neurovascular compression of the trigeminal nerve (CN V). Although the CN V has been extensively studied at the site of neurovascular compression, many pathophysiological factors remain obscure. For example, thalamic-somatosensory function is thought to be altered in TN, but the abnormalities are inadequately characterized. Furthermore, there are few studies using 7-T MRI to examine patients with TN. The purpose of the present study was to use 7-T MRI to assess microstructural alteration in the thalamic-somatosensory tracts of patients with TN by using ultra-high field MRI. METHODS Ten patients with TN and 10 age- and sex-matched healthy controls underwent scanning using 7-T MRI with diffusion tensor imaging. Structural images were segmented with an automated algorithm to obtain thalamus and primary somatosensory cortex (S1). Probabilistic tractography was performed between the thalamus and S1, and the microstructure of the thalamic-somatosensory tracts was compared between patients with TN and controls. RESULTS Fractional anisotropy of the thalamic-somatosensory tract ipsilateral to the site of neurovascular compression was reduced in patients (mean 0.43) compared with side-matched controls (mean 0.47, p = 0.01). The mean diffusivity was increased ipsilaterally in patients (mean 6.58 × 10-4 mm2/second) compared with controls (mean 6.15 × 10-4 mm2/second, p = 0.02). Radial diffusivity was increased ipsilaterally in patients (mean 4.91 × 10-4 mm2/second) compared with controls (mean 4.44 × 10-4 mm2/second, p = 0.01). Topographical analysis revealed fractional anisotropy reduction and diffusivity elevation along the entire anatomical S1 arc in patients with TN. CONCLUSIONS The present study is the first to examine microstructural properties of the thalamic-somatosensory anatomy in patients with TN and to evaluate quantitative differences compared with healthy controls. The finding of reduced integrity of these white matter fibers provides evidence of microstructural alteration at the level of the thalamus and S1, and furthers the understanding of TN neurobiology.
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Affiliation(s)
- John W Rutland
- 1Translational and Molecular Imaging Institute, and
- Departments of2Neurosurgery
| | | | | | | | - Judy Alper
- 1Translational and Molecular Imaging Institute, and
| | - Gaurav Verma
- 1Translational and Molecular Imaging Institute, and
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Hughes MA, Jani RH, Fakhran S, Chang YF, Branstetter BF, Thirumala PD, Sekula RF. Significance of degree of neurovascular compression in surgery for trigeminal neuralgia. J Neurosurg 2020; 133:411-416. [PMID: 31200377 DOI: 10.3171/2019.3.jns183174] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/19/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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 < 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). CONCLUSIONS In patients with cTN undergoing MVD, severe NVC on preoperative MRI is a strong predictor of an excellent surgical outcome.
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Affiliation(s)
| | | | | | | | | | - Parthasarathy D Thirumala
- 3Neurology, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Müller S, Khadhraoui E, Khanafer A, Psychogios M, Rohde V, Tanrikulu L. Differentiation of arterial and venous neurovascular conflicts estimates the clinical outcome after microvascular decompression in trigeminal neuralgia. BMC Neurol 2020; 20:279. [PMID: 32664930 PMCID: PMC7359280 DOI: 10.1186/s12883-020-01860-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Balanced Steady State Free Precession (b-SSFP) sequences and the newly developed Fast-Spin-Echo (FSE)-sequences enable an optimized visualization of neurovascular compression (NVC) in patients with trigeminal neuralgia (TN). Arterial conflicts are mostly associated with a favorable outcome of microvascular decompression (MVD) compared to venous conflicts. An additional Time-of-Flight (TOF) angiography provides the differentiation between offending arteries and veins and a precise counselling of the patient concerning postoperative pain relief. The goal of this study was to analyze the reliability and impact of the combination of highly-resoluted MRI techniques on the correct prediction of the vessel type and the estimation of postoperative outcome of microvascular decompression (MVD). METHODS In total, 48 patients (m/f: 32/16) underwent MVD for TN. All the preoperative imaging data (T2: b-SFFP and FSE, MRA: TOF) were compared to the intraoperative microsurgical findings during MVD. b-SFFP was available in 14 patients, FSE in 34 patients and an additional TOF sequence was available in 38 patients (9 times in combination with b-SSFP, 29 times in combination with FSE). The patients were categorized into four subgroups: 1) NVC negative, 2) venous NVC, 3) arterial NVC, 4) combined arterial and venous NVC. The preoperative MRI findings were compared to the intraoperative morphological findings. Postoperative pain relief was quantified by the Barrow Neurological Institute pain score. RESULTS Twenty-five purely arterial NVC, 9 purely venous NVC and 5 combined arterial and venous NVC were detected by MRI. In 9 cases NVC was absent on MRI. Overall, the MRI findings correctly predicted the intraoperative findings in 91.7% of the 48 patients. The percentage of correct prediction increased from 80 to 94.7%, when TOF angiography was adjoined. CONCLUSION The visualization of the trigeminal nerve using sequences such as b-SSFP or FSE in combination with TOF angiography enables an optimized delineation of arterial and venous neurovascular conflicts and may allow a more reliable differentiation between veins and arteries, resulting in superior prediction of postoperative pain relief compared to T2 imaging data alone.
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Affiliation(s)
- Sebastian Müller
- Departments of Neurosurgery, Georg-August-University Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.,Departments of Neuroradiology, Georg-August-University Goettingen, Göttingen, Germany
| | - Eya Khadhraoui
- Departments of Neuroradiology, Georg-August-University Goettingen, Göttingen, Germany
| | - Ali Khanafer
- Departments of Neuroradiology, Georg-August-University Goettingen, Göttingen, Germany
| | - Marios Psychogios
- Departments of Neuroradiology, Georg-August-University Goettingen, Göttingen, Germany
| | - Veit Rohde
- Departments of Neurosurgery, Georg-August-University Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Levent Tanrikulu
- Departments of Neurosurgery, Georg-August-University Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
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Whyte A, Matias MATJ. Imaging of orofacial pain. J Oral Pathol Med 2020; 49:490-498. [PMID: 32531821 DOI: 10.1111/jop.13063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Orofacial pain is a common complaint, with an estimated 75% of cases caused by dental disease, specifically a diseased pulp. A small percentage of orofacial pain cases will require specialist referral most commonly to oral medicine specialists or oral and maxillofacial surgeons from a dental perspective, or otolaryngologists or neurologists from a medical perspective. IMAGING MODALITIES Following a thorough history and clinical examination, imaging is often required to narrow the differential diagnosis or answer a specific query related to the final diagnosis. A range of imaging modalities can be used to evaluate orofacial pain including dental panoramic tomography (DPT), intraoral radiographs, cone beam computed tomography (CBCT), multidetector computed tomography (MDCT), ultrasonography (US), magnetic resonance imaging (MRI) and nuclear medicine. IMAGING PROTOCOLS This paper provides a guideline outlining imaging protocols for categories of facial pain divided into: (a) unilateral odontalgia; (b) unilateral facial pain; (c) combined unilateral odontalgia and facial pain; (d) trigeminal neuralgia; (e) trigeminal neuropathic pain with or without other sensory, autonomic or motor features; (f) temporomandibular joint disorders and associated pain; (g) referred pain and (h) non-specific orofacial pain. CONCLUSION Imaging for orofacial pain should be tailored to answer a specific query related to the aetiology of the reported pain. This should result in a specific diagnosis or narrowing of the differential diagnosis as possible causes of orofacial pain are eliminated. Choosing the correct imaging modality and protocol based on the pain category is important for efficient and effective pain diagnosis and management.
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Affiliation(s)
- Andy Whyte
- Perth Radiological Clinic, Subiaco, WA, Australia
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49
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Lee YL, Chen ST, Yang JT, Weng HH, Wang HL, Tsai YH. Diffusivity parameters of diffusion tensor imaging and apparent diffusion coefficient as imaging markers for predicting the treatment response of patients with trigeminal neuralgia. J Neurosurg 2020; 132:1993-1999. [PMID: 31100729 DOI: 10.3171/2019.2.jns183008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/19/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is facial pain that is usually caused by neurovascular compression syndrome and is characterized by suddenly intense and paroxysmal pain. Radiofrequency lesioning (RFL) is one of the major treatments for TN, but the treatment response for RFL is sometimes inconsistent, and the recurrence of TN is not uncommon. This study aimed to estimate the outcome predictors of TN treated with RFL by using the parameters of diffusion tensor imaging (DTI). METHODS Fifty-one patients with TN who were treated with RFL were enrolled in the study. MRI was performed in all patients within 1 week before surgery. The visual analog scale was used to evaluate symptom severity at three time points: before, 1 week after, and 3 months after RFL. The involved cisternal segment of the trigeminal nerves was manually selected, and the histograms of each of the diffusivity metrics-including the apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD)-were measured. The differences in the means, as well as the kurtosis and skewness of each of the diffusivity metrics between the nonrecurrent and recurrent groups, were then analyzed using the Mann-Whitney U-test. RESULTS There were significantly lower kurtosis values (a broader peak of the distributional curves) for both FA and ADC in the recurrent group (p = 0.0004 and 0.015, respectively), compared to the nonrecurrent group. The kurtoses of AD and RD, as well as the mean and skewness of all other diffusivity metrics, did not show significant differences between the two groups. CONCLUSIONS The pretreatment diffusivity metrics of DTI and ADC may be feasible imaging biomarkers for predicting the outcome of TN after RFL. A clarification of the kurtosis value of FA and ADC is helpful for determining the prognosis of patients after RFL.
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Affiliation(s)
- Yu-Li Lee
- Departments of1Diagnostic Radiology and
| | | | - Jen-Tsung Yang
- 2Neurosurgery, Chang Gung Memorial Hospital, Chiayi branch, Chiayi; and
| | | | | | - Yuan-Hsiung Tsai
- Departments of1Diagnostic Radiology and
- 3College of Medicine, Chang Gung University, Taoyuan, Taiwan
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50
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Hu YS, Lee CC, Guo WY, Lin CJ, Yang HC, Wu HM, Liu KD, Chung WY. Trigeminal Nerve Atrophy Predicts Pain Recurrence After Gamma Knife Stereotactic Radiosurgery for Classical Trigeminal Neuralgia. Neurosurgery 2020; 84:927-934. [PMID: 29660047 DOI: 10.1093/neuros/nyy122] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/13/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Trigeminal nerve atrophy and neurovascular compression (NVC) are frequently observed in classical trigeminal neuralgia (CTN). OBJECTIVE To determine whether nerve characteristics contribute to Gamma Knife (Elekta AB, Stockholm, Sweden) surgery (GKS) outcomes in unilateral CTN without previous surgery. METHODS From 2006 to 2012, 67 patients with unilateral CTN without previous surgery received GKS with a maximal dose of 90 Gy delivered to the trigeminal nerve juxta brainstem. Two evaluators, blinded to the side of pain, analyzed the magnetic resonance images before GKS to obtain the parameters, including nerve cross-sectional area (CSA), vessel type of NVC, and site of NVC along the nerve. Correlations of the parameters with pain relief (Barrow Neurological Institute [BNI] grades I-IIIb) and recurrence (BNI grades VI-V) were made by using Cox regression and Kaplan-Meier analyses. RESULTS The median CSA of the symptomatic nerves was significantly smaller than that of the asymptomatic nerves (4.95 vs 5.9 mm2, P < .001). After adjustment for age and sex, larger nerve CSA was associated with lower initial pain relief (hazard ratio 0.81, P = .03) and lower pain recurrence after initial response (hazard ratio 0.58, P = .02). Patients with nerve atrophy (CSA of ≤ 4.4 mm2 after receiver operating characteristic curve analysis) had a lower 5-yr probability of maintaining pain relief after initial response than those without nerve atrophy (65% vs 86%, P = .04). CONCLUSION Trigeminal nerve atrophy may predict pain recurrence in patients with initial post-GKS relief of CTN. Arterial and proximal NVC are not predictive of GKS outcomes. Future studies are required to determine optimal treatments for long-term pain relief in patients with CTN and trigeminal nerve atrophy.
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Affiliation(s)
- Yong-Sin Hu
- Department of Radiology, Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Cheng-Chia Lee
- School of Medicine, National Yang Ming University, Taipei, Taiwan.,Neurological Institute, Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Yuo Guo
- Department of Radiology, Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chung-Jung Lin
- Department of Radiology, Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- School of Medicine, National Yang Ming University, Taipei, Taiwan.,Neurological Institute, Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiu-Mei Wu
- Department of Radiology, Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Kang-Du Liu
- School of Medicine, National Yang Ming University, Taipei, Taiwan.,Neurological Institute, Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Yuh Chung
- School of Medicine, National Yang Ming University, Taipei, Taiwan.,Neurological Institute, Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
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