Preoperative MRI/MRA for microvascular decompression in trigeminal neuralgia: consecutive series of 67 patients

Vergani, Francesco; Panaretos, P; Penalosa, Alvin; English, Philip; Nicholson, Claire; Jenkins, Alistair

doi:10.1007/s00701-011-1135-x

Cited by 29 publications

(15 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…No randomized controlled trials (RCTs) were identified. Fifteen studies were found investigating the accuracy of preoperative imaging examination to predict the presence of NVC [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]. All studies compared the preoperative imaging analysis with surgical data.…”

Section: Search Strategy and Resultsmentioning

confidence: 99%

“…All studies compared the preoperative imaging analysis with surgical data. Nine studies were performed using a 1.5-T MR scanner [34,36,38,[40][41][42][43]45,46], six with a 3-T scanner [35,37,39,44,47,48], five studies applied an imaging protocol with only 3D TOF-MRA [34,37,40,43,45]; five with a combination of 3D T2-weighted and 3D TOF-MRA [36,38,39,42,46]; two with a combination of 3D T2-weighted, 3D TOF-MRA and 3D T1-Gad [41,48]; two with a combination of 3D TOF-MRA and 3D T1-Gad [35,47]; and one study with a combination of 3D T2-weighted and 3D fluid-attenuated inversion recovery (FLAIR) [44]. The sensitivity and the specificity of the imaging protocol in detecting NVC varied, respectively, from 67% to 100% and from 50% to 100%.…”

Section: Search Strategy and Resultsmentioning

confidence: 99%

See 1 more Smart Citation

European Academy of Neurology guideline on trigeminal neuralgia

Bendtsen

Zakrzewska

Abbott

et al. 2019

Euro J of Neurology

368

445

View full text Add to dashboard Cite

Background and purpose Trigeminal neuralgia (TN) is an extremely painful condition which can be difficult to diagnose and treat. In Europe, TN patients are managed by many different specialities. Therefore, there is a great need for comprehensive European guidelines for the management of TN. The European Academy of Neurology asked an expert panel to develop recommendations for a series of questions that are essential for daily clinical management of patients with TN. Methods A systematic review of the literature was performed and recommendations was developed based on GRADE, where feasible; if not, a good practice statement was given. Results The use of the most recent classification system is recommended, which diagnoses TN as primary TN, either classical or idiopathic depending on the degree of neurovascular contact, or as secondary TN caused by pathology other than neurovascular contact. Magnetic resonance imaging (MRI), using a combination of three high‐resolution sequences, should be performed as part of the work‐up in TN patients, because no clinical characteristics can exclude secondary TN. If MRI is not possible, trigeminal reflexes can be used. Neurovascular contact plays an important role in primary TN, but demonstration of a neurovascular contact should not be used to confirm the diagnosis of TN. Rather, it may help to decide if and when a patient should be referred for microvascular decompression. In acute exacerbations of pain, intravenous infusion of fosphenytoin or lidocaine can be used. For long‐term treatment, carbamazepine or oxcarbazepine are recommended as drugs of first choice. Lamotrigine, gabapentin, botulinum toxin type A, pregabalin, baclofen and phenytoin may be used either alone or as add‐on therapy. It is recommended that patients should be offered surgery if pain is not sufficiently controlled medically or if medical treatment is poorly tolerated. Microvascular decompression is recommended as first‐line surgery in patients with classical TN. No recommendation can be given for choice between any neuroablative treatments or between them and microvascular decompression in patients with idiopathic TN. Neuroablative treatments should be the preferred choice if MRI does not demonstrate any neurovascular contact. Treatment for patients with secondary TN should in general follow the same principles as for primary TN. In addition to medical and surgical management, it is recommended that patients are offered psychological and nursing support. Conclusions Compared with previous TN guidelines, there are important changes regarding diagnosis and imaging. These allow better characterization of patients and help in decision making regarding the planning of medical and surgical management. Recommendations on pharmacological and surgical management have been updated. There is a great need for future research on all aspects of TN, including pathophysiology and management.

show abstract

Section: Search Strategy and Resultsmentioning

confidence: 99%

Section: Search Strategy and Resultsmentioning

confidence: 99%

European Academy of Neurology guideline on trigeminal neuralgia

Bendtsen

Zakrzewska

Abbott

et al. 2019

Euro J of Neurology

368

445

View full text Add to dashboard Cite

show abstract

“…Thus, MRIs provide the neurosurgeon with a clearer idea of what will be found at operation but many have not used the results of the preoperative findings to act as prognosticators. In a small retrospective study on 67 patients in which 6 cases had negative findings on MRI but MVDs were carried out, no correlation between pain outcomes and preoperative MRI findings was detected [12]. However, it needs to be noted that only four out of six MRI-negative patients were available for follow-up and nine patients in the positive group had a poor pain relief outcome.…”

Section: Preoperative Investigationsmentioning

confidence: 80%

“…These results agree with other studies and also confirm that the greatest number of recurrences occur in the first 2 years [6 && ]. One to two percent may not get pain relief at all [3 & ,6 && ], but the series by Vergani et al [12] had a much higher figure of 18%. ].…”

Section: Key Pointsmentioning

confidence: 98%

Microvascular decompression for trigeminal neuralgia

Zakrzewska

Coakham

2012

Current Opinion in Neurology

View full text Add to dashboard Cite

Microvascular decompression in correctly diagnosed patients is probably the most effective therapy. However, high-quality prospective studies of MVD in a population that has been well phenotyped and which is assessed pre and postoperatively using psychometrically tested questions, administered at regular intervals by independent observers, are needed to provide clear evidence of its superiority over medical therapies.

show abstract

“…The present study using 3D-TOF MRA and FIESTA has achieved high diagnostic accuracy as 94.5% for symptomatic nerve. For the assessment method, some studies only performed dichotomous assessment methods such as patients with or without NVC (20,21). T. Satoh et al classi ed the NVC severity into four grades according to the extent of the nerve circumference in contact with the vessel (22).…”

Section: Discussionmentioning

confidence: 99%

MRI-derived neurovascular compression score provides the indication of surgical treatment of patients with primary trigeminal neuralgia: A validated multi-center study

Shen

Zhou

Shen

et al. 2020

Preprint

View full text Add to dashboard Cite

Abstract Background The radiological assessment of neurovascular compression (NVC) is various regarding MRI techniques and assessing methods in patients with trigeminal neuralgia (TN), and the false-positive rate of MRI findings is not low. Better MRI techniques with the NVC assessing method are warranted to be determined. This study aims to investigate the diagnostic performance of 3D TOF MRA and 3D Fast Imaging Employing Steady-state Acquisition (FIESTA) with a novel NVC scoring system in TN patients. Methods Patients with confirmed TN who underwent MRI studies before microvascular decompression (MVD) were retrospectively included into the study. A new NVC scoring system based on the contact relationship of the trigeminal nerve and the vessel was performed to assess the NVC in the symptomatic and contralateral asymptomatic side. The radiological finding was correlated with the intraoperative result to figure out the diagnostic accuracy of MRI techniques. Besides, the comparison of both sides was performed to determine the radiological indicator of MVD. Results Seventy-three TN patients were recruited, and 146 trigeminal nerve sides were analyzed. For the symptomatic sides, 69 patients had surgically confirmed offending vessels, most of which was SCA, and the positive NVC rate was 95.5%. For the contralateral side, 33 patients have been found with NVC on MRI. The NVC score of the symptomatic side was significantly higher than that of asymptomatic sides (6.7 vs. 1.6; p < 0.001). The optimal cut-off value in predicting trigeminal neuralgia was found as NVC > 4 with sensitivity and specificity of 82.2% and 98.6%, respectively. Conclusion 3D-TOF MRA and FIESTA enable a good diagnostic performance of NVC, and NVC score > 4 was identified to predict trigeminal neuralgia, suggestive of subsequent surgical treatment. Trial registration: The study has been retrospectively registered at the local ethical Institution Review Board (IRB) of Huzhou Central Hospital and Sir Run Run Shaw Hospital with the IRB number (20181108-01; Huzhou) and (20200423-43; SRRSH).

show abstract

Preoperative MRI/MRA for microvascular decompression in trigeminal neuralgia: consecutive series of 67 patients

Abstract: Preoperative MRI has both good sensitivity and positive predictive value. Specificity and negative predicitve value were limited in this series. No correlation was found between preoperative imaging and outcome. Both radiological and clinical criteria are important for patient selection.

Cited by 29 publications

References 17 publications

European Academy of Neurology guideline on trigeminal neuralgia

European Academy of Neurology guideline on trigeminal neuralgia

Microvascular decompression for trigeminal neuralgia

MRI-derived neurovascular compression score provides the indication of surgical treatment of patients with primary trigeminal neuralgia: A validated multi-center study

Contact Info

Product

Resources

About