The Role of Preoperative Magnetic Resonance Imaging in Assessing Neurovascular Compression Before Microvascular Decompression in Trigeminal Neuralgia

Xu, Risheng; Nair, Sumil K.; Raj, Divyaansh; Materi, Joshua; So, Raymond J.; Gujar, Sachin K.; Huang, Judy; Blitz, Ari M.; Lim, Michael; Sair, Haris I.; Bettegowda, Chetan

doi:10.1016/j.wneu.2022.09.092

Cited by 9 publications

(6 citation statements)

References 22 publications

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“…Interestingly, this patient was the one who experienced persistent pain after MVD (Table 1). The reported specificity and sensitivity of MRI in identifying neurovascular conflicts in the CN V are far from reaching 100% [8,9]. Therefore, while the accuracy of imaging studies is improved, the diagnosis of TN with CCP relies mainly on clinical features.…”

Section: Resultsmentioning

confidence: 99%

Histochemical Analysis of Altered Arachnoid Tissue in Patients With Paroxysmal Trigeminal Neuralgia With Concomitant Continuous Pain

Segura-Lozano,

Carranza-Rentería,

Velázquez-Delgado

et al. 2024

Cureus

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BackgroundTrigeminal neuralgia (TN) is a craniofacial pain characterized by sudden onset, brief, severe, recurrent shooting pain within one or more branches of the trigeminal nerve (CN V). Based on its clinical presentation, TN may be classified as purely paroxysmal or paroxysmal with concomitant continuous pain (CCP), previously known as typical and atypical, respectively. Microvascular decompression (MVD) surgery for releasing the CN V from a neurovascular conflict is an effective and safe treatment for TN. During MVD of patients manifesting TN with CCP, the involvement of an abnormal arachnoid tissue is a common finding. The etiology and pathophysiology behind the appearance of this tissue are unknown; however, it is more commonly found in this variant of the disease. MethodsFrom January 2015 to December 2016, a total of 330 patients diagnosed with TN were evaluated at our clinic. Among them, 31 individuals (9.4%) presented with paroxysmal TN with CCP, with 16 patients (51.6%) undergoing MVD. During surgery, samples of altered arachnoid tissue were collected from five patients and subjected to Hematoxylin-Eosin staining and immunohistochemistry for S100 and CD2 ResultsIn a long-term follow-up, 80% of patients operated by DMV remains pain free. Analysis of biopsies revealed chronic fibrosis (n=4), hyperplasia of neurothelial cells (n=3), dystrophic calcifications (n=1). Immunohistochemistry was positive for S100 (n=3) and CD20 (n=3) inflammatory markers. ConclusionChronic inflammation in the arachnoid tissue involved in paroxysmal TN with CCP could be a contributor to the pathophysiology of this variant of the disease.

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Section: Resultsmentioning

confidence: 99%

Histochemical Analysis of Altered Arachnoid Tissue in Patients With Paroxysmal Trigeminal Neuralgia With Concomitant Continuous Pain

Segura-Lozano,

Carranza-Rentería,

Velázquez-Delgado

et al. 2024

Cureus

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“…A cranial MRI exam is the first choice for evaluating the contact between blood vessels and nerves. Preoperative MRI sensitivity is 75.8%, with a specificity of 65.8%, and positive- and negative-predictive values of 92.4 and 33.3%, respectively, for MVD ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

“…Although preoperative MRI has a high positive-predictive value and sensitivity, a relatively low negative-predictive value reduces its usefulness in patients without vascular compression of nerves from MVD. Therefore, performing MVD should be coordinated with clinical manifestations and imaging; many MRI patients with negative compression may still benefit from MVD ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Trigeminal neuralgia misdiagnosed as glossopharyngeal neuralgia

Xiong

Huang

et al. 2023

Front. Neurol.

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BackgroundTrigeminal neuralgia (TN) and glossopharyngeal neuralgia (GPN) are cranial nerve neuralgias with the same clinical manifestations, pathological features, and trigger factors; their affected sites are adjacent. Performing a magnetic resonance imaging (MRI) examination alone can easily lead to a misdiagnosis.Case presentationA 72-year-old man had visited another hospital with severe left-sided tongue pain. On MRI, vascular compression of the glossopharyngeal nerve had been visible, with unclear evidence of trigeminal nerve involvement. He had been diagnosed with left-sided GPN and underwent microvascular decompression (MVD) of the left glossopharyngeal nerve. However, no improvement was observed after surgery. During a second surgery at our hospital, MVD of the trigeminal nerve was performed, and the trigeminal nerve was fully explored and separated. The patient's pain resolved after surgery. Ultimately, the patient was definitively diagnosed with left-sided TN.Discussion and conclusionMVD is currently the most efficacious surgical option for treating cranial nerve neuralgia. To select patients for MVD, having an MRI criteria for identifying true neurovascular compression will be helpful. However, clinicians should focus more on a patient's clinical symptoms and not rely solely on MRI findings. This patient's case can help clinicians distinguish between TN and GPN, improve the understanding of these diseases, avoid misdiagnosis, and reduce the possibility of secondary damage.

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“…In clinical practice, modern neuroimaging protocols are routinely used to assess the presence and severity of neurovascular conflict and evaluate microstructural changes in the trigeminal nerve [47]. MRI-derived biomarkers have repeatedly demonstrated their ability to predict pain intensity and treatment outcomes [23].…”

Section: Introductionmentioning

confidence: 99%

Thalamic nuclei in patients with chronic facial pain: gray matter volume patterns before and after surgery

Anton,

Elena,

Boris

et al. 2023

Preprint

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Trigeminal neuralgia is a prevalent chronic pain disorder characterized by recurring episodes of intense facial pain, which significantly impairs patients’ quality of life. MRI-based biomarkers have consistently demonstrated their ability to predict pain intensity and treatment outcomes. However, most studies have primarily focused on the trigeminal system, disregarding the extensive neural reorganization that occurs throughout the brain in response to chronic pain. In this study, we aimed to examine the thalamus, a key brain structure involved in information processing, and provide a detailed perspective on thalamic remodeling in response to chronic pain at the level of individual thalamic nuclei. We analyzed a sample of 61 patients with primary trigeminal neuralgia undergoing surgical treatment, along with 28 healthy participants. Our results revealed significant gray matter volume changes in thalamic nuclei among patients with trigeminal neuralgia. Notably, the intralaminar nuclei (centromedian/parafascicular) and nuclei associated with visual and auditory signal processing (lateral and medial geniculate bodies) exhibited significant alterations, contrasting with the ventral group nuclei involved in nociceptive processing. Additionally, we found no substantial volume increase in any of the studied nuclei following successful surgical intervention. The volumes of thalamic nuclei were negatively correlated with pain intensity and disease duration, while positively correlated with working memory scores. The findings obtained in this study, albeit preliminary, have promising clinical implications as they unveil previously unknown facets of chronic pain development and provide valuable guidance for clinical decision-making.

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The Role of Preoperative Magnetic Resonance Imaging in Assessing Neurovascular Compression Before Microvascular Decompression in Trigeminal Neuralgia

Cited by 9 publications

References 22 publications

Histochemical Analysis of Altered Arachnoid Tissue in Patients With Paroxysmal Trigeminal Neuralgia With Concomitant Continuous Pain

Histochemical Analysis of Altered Arachnoid Tissue in Patients With Paroxysmal Trigeminal Neuralgia With Concomitant Continuous Pain

Case report: Trigeminal neuralgia misdiagnosed as glossopharyngeal neuralgia

Thalamic nuclei in patients with chronic facial pain: gray matter volume patterns before and after surgery

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