Trigeminal Nerve Compression Without Trigeminal Neuralgia: Intraoperative vs Imaging Evidence

Jani, Ronak H.; Hughes, Marion A.; Gold, Michael S.; Branstetter, Barton F.; Ligus, Zachary E; Sekula, Raymond F.

doi:10.1093/neuros/nyx636

Cited by 29 publications

(16 citation statements)

References 31 publications

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“…In our study, we found similar results that the atypical TN patients achieved a lower rate of excellent pain relief. Previous studies showed that vascular contact with the trigeminal nerve is universal (occurring in 82 to 92%) [15]. Nevertheless, several papers showed that neurovascular compression on MRI remains important for predicting postoperative outcome following MVD [22,29].…”

Section: Discussionmentioning

confidence: 99%

Prognostic nomogram for percutaneous balloon compression in the treatment of trigeminal neuralgia

Liu

Tang

et al. 2021

Neurosurg Rev

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Because of its convenience and safety, percutaneous balloon compression (PBC) has become a more popular remedy for trigeminal neuralgia (TN) recently. The objective of this study was to establish a nomogram that can be used to preoperatively prognosticate the likelihood of pain-free based on preoperative disease characteristics. Clinical data were collected from those TN cases who had undergone PBC during the period of 2015 and 2020 in Qingdao municipal hospital. We excluded the cases caused by space-occupying lesion or had undergone MVD, Percutaneous glycerol rhizotomy (PGR) and glycerol rhizotomy (GR). A nomogram was established based on the results of multivariable logistic analysis. A receiver operating characteristic curve (ROC) analysis was applied to evaluate the reliability of models. The plotted decision curves were also used to assess the net bene t of nomogram-assisted decisions. Internal validation was performed using the ROC by bootstrap sampling. Finally, 16 cases and 69 cases were included into the ineffective and effective groups respectively. In the crude, adjust I and adjust II models, response to carbamazepine positively, the grade II or III compression severity score and classical TN type were all considered to be signi cant predictors of pain relief (BNI grades I-III) at 3 months follow-up. The AUC, accuracy, speci city, and sensitivity of the nomogram system was 0.83, 0.85, 0.75, 0.87 respectively for predicting patient outcomes. The decision curves showed good performance for the nomogram system in terms of clinical application. While, more research with validation in multiple, external independent patient populations is needed.

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Section: Discussionmentioning

confidence: 99%

Prognostic nomogram for percutaneous balloon compression in the treatment of trigeminal neuralgia

Liu

Tang

et al. 2021

Neurosurg Rev

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“…Literature reveals considerable interest in characterization of CNs in assessment of various skull base pathologies, including pituitary adenomas, 7,14 trigeminal neuralgia, [17][18][19] vestibular schwannomas, 20,21 and among others. 22 Those studies have examined conventional imaging 7,17,18 and advanced sequences, such as diffusion tensor imaging (DTI) [19][20][21][22] in CN assessment. This study indicates that several CNs are better imaged at 7 T MRI compared with conventional MRI, suggesting that this technology could aid in localization and protection of nerves intraoperatively.…”

Section: Imaging the Cranial Nervesmentioning

confidence: 99%

Utility of 7 Tesla MRI for Preoperative Planning of Endoscopic Endonasal Surgery for Pituitary Adenomas

Rutland

Delman

Feldman

et al. 2019

J Neurol Surg B Skull Base

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Object There is increasing interest in investigating the utility of 7 Tesla (7 T) magnetic resonance imaging (MRI) for imaging of skull base tumors. The present study quantifies visualization of tumor features and adjacent skull base anatomy in a homogenous cohort of pituitary adenoma patients. Methods Eighteen pituitary adenoma patients were scanned at 7 T in this prospective study. All patients had reference standard-of-care clinical imaging at either 3 T (7/18, 39%) or 1.5 T (11/18, 61%). Visualization of tumor features and conspicuity of arteries and cranial nerves (CNs) was rated by an expert neuroradiologist on 7 T and clinical field strength MRI. Overall image quality and severity of image artifacts were also characterized and compared. Results Ability to visualize tumor features did not differ between 7 T and lower field MRI. Cranial nerves III, IV, and VI were better detected at 7 T compared with clinical field strength scans. Cranial nerves III, IV, and VI were also better detected at 7 T compared with only 1.5 T, and CN III was better visualized at 7 T compared with 3 T MRI. The ophthalmic arteries and posterior communicating arteries (PCOM) were better detected at 7 T compared with clinical field strength imaging. The 7 T also provided better visualization of the ophthalmic arteries compared with 1.5 T scans. Conclusions This study demonstrates that 7 T MRI is feasible at the skull base and identifies various CNs and branches of the internal carotid artery that were better visualized at 7 T. The 7 T MRI may offer important preoperative information that can help to guide resection of pituitary adenoma and reduce operative morbidity.

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“…The pathogenesis of “classical TN (cTN)” is frequently attributed to hyperexcitability of trigeminal ganglion neurons ( Burchiel, 1980a , 1980b ; Burchiel and Baumann, 2004 ; Devor et al., 2002 ) secondary to morphological compression of the trigeminal nerve root entry root by the cerebral vasculature (i.e., neurovascular compression [NVC]) ( Headache Classification Committee of the International Headache Society (IHS), 2013 ; Cruccu et al., 2016 ; Gardner and Miklos, 1959 ; Hilton et al., 1994 ; Rappaport et al., 1997 ). However, asymptomatic NVC has been noted in ∼13%–85% of asymptomatic subjects ( Haines et al., 1980 ; Hamlyn, 1997a , 1997b ; Jani et al., 2019 ). Other cases of TN are related to trigeminal nerve infection (e.g., herpes zoster), trauma, demyelination (as in multiple sclerosis), or compression from a space-occupying lesion in the cerebello-pontine angle and are termed “secondary TN.” However, a significant number of TN cases lack a demonstrable cause (“idiopathic TN [iTN]”) ( Hughes et al, 2019 ; Maarbjerg et al., 2017 ), including some cases with bilateral symptoms ( Brisman, 1987 ; Pollack et al., 1988 ).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Summary Trigeminal neuralgia (TN) is a common, debilitating neuropathic face pain syndrome often resistant to therapy. The familial clustering of TN cases suggests that genetic factors play a role in disease pathogenesis. However, no unbiased, large-scale genomic study of TN has been performed to date. Analysis of 290 whole exome-sequenced TN probands, including 20 multiplex kindreds and 70 parent-offspring trios, revealed enrichment of rare, damaging variants in GABA receptor-binding genes in cases. Mice engineered with a TN-associated de novo mutation (p.Cys188Trp) in the GABA A receptor Cl − channel γ-1 subunit ( GABRG1 ) exhibited trigeminal mechanical allodynia and face pain behavior. Other TN probands harbored rare damaging variants in Na + and Ca + channels, including a significant variant burden in the α-1H subunit of the voltage-gated Ca 2+ channel Ca v 3.2 ( CACNA1H ). These results provide exome-level insight into TN and implicate genetically encoded impairment of GABA signaling and neuronal ion transport in TN pathogenesis.

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Trigeminal Nerve Compression Without Trigeminal Neuralgia: Intraoperative vs Imaging Evidence

Abstract: There was moderate agreement between imaging and operative findings with respect to both the presence and severity of NVC/C.

Cited by 29 publications

References 31 publications

Prognostic nomogram for percutaneous balloon compression in the treatment of trigeminal neuralgia

Prognostic nomogram for percutaneous balloon compression in the treatment of trigeminal neuralgia

Utility of 7 Tesla MRI for Preoperative Planning of Endoscopic Endonasal Surgery for Pituitary Adenomas

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

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