The timing of stereotactic radiosurgery for medically refractory trigeminal neuralgia: the evidence from diffusion tractography images

Abstract

SRS provides high rates of initial pain relief with moderate rates of facial hypoesthesia. Ipsilateral trigeminal nerve was associated with higher baseline REZ Cs, and baseline FA was associated with duration of symptoms. There were significant associations between duration of symptoms and changes in ipsilateral REZ Cl, cisternal segment FA, and cisternal segment λ after SRS. These preliminary findings serve as comparisons for future studies investigating the use of DTI in radiosurgical planning for patients with TN.

Application of diffusion tensor imaging in detecting microstructural alteration of the trigeminal nerve root in patients with classical trigeminal neuralgia without neurovascular compression

“…DTI abnormalities in the trigeminal nerve root of TN trigeminal nerve in 21 cases of TN before and after stereotactic radiosurgery (SRS), and focused on the cisternal segment of trigeminal nerves on affected side, in symptoms of < 5 years cases were associated with decreased FA ,while in symptoms of ≧ 5 years cases were associated with increased FA post-SRS. [15] From the results of our study, not only the mean values of FA and ADC showed signi cant differences between affected and unaffected sides, affected and control's sides, but also the kurtosis of FA and ADC behaved signi cant higher differences between affected and unaffected sides, affected and control's sides. The former nding is consistent with the mainstream opinion of above studies, the latter may elucidate further understanding of TN1 woNVC.…”

Traumatic trigeminal neuropathy after whiplash injury

“…Since introduction of DTI, many DTT-based studies have demonstrated trigeminal neuropathy in various neurological diseases including classical trigeminal neuralgia, brain tumor, neurovascular compression, and multiple sclerosis. [11][12][13][14][15][16][17][18][19][20] As a result, to the best of our knowledge, this is the first case study to report on the presence of traumatic trigeminal neuropathy following whiplash. However, the limitation of this study regarding DTT should be considered; DTT can produce both false positive and false negative results throughout the white matter of the brain due to complex fiber configurations such as crossing or kissing fibers and/or partial volume effects.…”

“…However, these previous studies could not demonstrate trigeminal neuropathy because the authors suspected trigeminal neuropathy based on questionnaire or neurological examination without radiologic evidences. Since introduction of DTI, many DTT-based studies have demonstrated trigeminal neuropathy in various neurological diseases including classical trigeminal neuralgia, brain tumor, neurovascular compression, and multiple sclerosis [11–20] . As a result, to the best of our knowledge, this is the first case study to report on the presence of traumatic trigeminal neuropathy following whiplash.…”

“…[10] Many previous studies using DTT have demonstrated trigeminal neuropathy in various neurological diseases, particularly trigeminal neuralgia. [11][12][13][14][15][16][17][18][19][20] However, no study on traumatic trigeminal neuropathy following whiplash has been reported.…”

“…By contrast, diffusion tensor tractography (DTT) which is a derivation of diffusion tensor imaging (DTI), allows 3-dimensional reconstruction and estimation of the trigeminal nerve [10] . Many previous studies using DTT have demonstrated trigeminal neuropathy in various neurological diseases, particularly trigeminal neuralgia [11–20] . However, no study on traumatic trigeminal neuropathy following whiplash has been reported.…”