The thalamus in trigeminal neuralgia: structural and metabolic abnormalities, and influence on surgical response.

Female Humans Magnetic Resonance Imaging Male Microvascular Decompression Surgery Rhizotomy Thalamus / diagnostic imaging Treatment Outcome Trigeminal Neuralgia / diagnostic imaging
MRI Microvascular decompression Percutaneous rhizotomy Spectroscopy Thalamus Volumetry

Journal

BMC neurology
ISSN: 1471-2377
Titre abrégé: BMC Neurol
Pays: England
ID NLM: 100968555

Informations de publication

Date de publication:
24 Jul 2021
Historique:
received: 05 04 2021
accepted: 09 07 2021
entrez: 25 7 2021
pubmed: 26 7 2021
medline: 7 10 2021
Statut: epublish

Résumé

Medically-refractory trigeminal neuralgia (TN) can be treated successfully with operative intervention, but a significant proportion of patients are non-responders despite undergoing technically successful surgery. The thalamus is a key component of the trigeminal sensory pathway involved in transmitting facial pain, but the role of the thalamus in TN, and its influence on durability of pain relief after TN surgery, are relatively understudied. We aimed to test the hypothesis that variations in thalamic structure and metabolism are related to surgical non-response in TN. We performed a longitudinal, peri-operative neuroimaging study of the thalamus in medically-refractory TN patients undergoing microvascular decompression or percutaneous balloon compression rhizotomy. Patients underwent structural MRI and MR spectroscopy scans pre-operatively and at 1-week following surgery, and were classified as responders or non-responders based on 1-year post-operative pain outcome. Thalamus volume, shape, and metabolite concentration (choline/creatine [Cho/Cr] and N-acetylaspartate/creatine [NAA/Cr]) were evaluated at baseline and 1-week, and compared between responders, non-responders, and healthy controls. Twenty healthy controls and 23 patients with medically-refractory TN treated surgically (17 responders, 6 non-responders) were included. Pre-operatively, TN patients as a group showed significantly larger thalamus volume contralateral to the side of facial pain. However, vertex-wise shape analysis showed significant contralateral thalamus volume reduction in non-responders compared to responders in an axially-oriented band spanning the outer thalamic circumference (peak p = 0.019). Further, while pre-operative thalamic metabolite concentrations did not differ between responders and non-responders, as early as 1-week after surgery, long-term non-responders showed a distinct decrease in contralateral thalamic Cho/Cr and NAA/Cr, irrespective of surgery type, which was not observed in responders. Atrophy of the contralateral thalamus is a consistent feature across patients with medically-refractory TN. Regional alterations in preoperative thalamic structure, and very early post-operative metabolic changes in the thalamus, both appear to influence the durability of pain relief after TN surgery.

Sections du résumé

BACKGROUND BACKGROUND
Medically-refractory trigeminal neuralgia (TN) can be treated successfully with operative intervention, but a significant proportion of patients are non-responders despite undergoing technically successful surgery. The thalamus is a key component of the trigeminal sensory pathway involved in transmitting facial pain, but the role of the thalamus in TN, and its influence on durability of pain relief after TN surgery, are relatively understudied. We aimed to test the hypothesis that variations in thalamic structure and metabolism are related to surgical non-response in TN.
METHODS METHODS
We performed a longitudinal, peri-operative neuroimaging study of the thalamus in medically-refractory TN patients undergoing microvascular decompression or percutaneous balloon compression rhizotomy. Patients underwent structural MRI and MR spectroscopy scans pre-operatively and at 1-week following surgery, and were classified as responders or non-responders based on 1-year post-operative pain outcome. Thalamus volume, shape, and metabolite concentration (choline/creatine [Cho/Cr] and N-acetylaspartate/creatine [NAA/Cr]) were evaluated at baseline and 1-week, and compared between responders, non-responders, and healthy controls.
RESULTS RESULTS
Twenty healthy controls and 23 patients with medically-refractory TN treated surgically (17 responders, 6 non-responders) were included. Pre-operatively, TN patients as a group showed significantly larger thalamus volume contralateral to the side of facial pain. However, vertex-wise shape analysis showed significant contralateral thalamus volume reduction in non-responders compared to responders in an axially-oriented band spanning the outer thalamic circumference (peak p = 0.019). Further, while pre-operative thalamic metabolite concentrations did not differ between responders and non-responders, as early as 1-week after surgery, long-term non-responders showed a distinct decrease in contralateral thalamic Cho/Cr and NAA/Cr, irrespective of surgery type, which was not observed in responders.
CONCLUSIONS CONCLUSIONS
Atrophy of the contralateral thalamus is a consistent feature across patients with medically-refractory TN. Regional alterations in preoperative thalamic structure, and very early post-operative metabolic changes in the thalamus, both appear to influence the durability of pain relief after TN surgery.

Identifiants

DOI: 10.1186/s12883-021-02323-4 PMID: 34303364 PMC: PMC8305513
pubmed: 34303364
doi: 10.1186/s12883-021-02323-4
pii: 10.1186/s12883-021-02323-4
pmc: PMC8305513
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

290

Informations de copyright

© 2021. The Author(s).

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Auteurs

Hayden Danyluk (H)

Division of Surgical Research, Department of Surgery, University of Alberta, 3-002 Li Ka Shing Centre For Research, 11203 - 87 Ave NW, Edmonton, AB, T6G 2H5, Canada.
Division of Neurosurgery, Department of Surgery, University of Alberta, 2D Department of Surgery, University of Alberta Hospital, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada.

Jennifer Andrews (J)

Division of Neurosurgery, Department of Surgery, University of Alberta, 2D Department of Surgery, University of Alberta Hospital, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada.

Rohit Kesarwani (R)

Division of Neurosurgery, Department of Surgery, University of Alberta, 2D Department of Surgery, University of Alberta Hospital, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada.

Peter Seres (P)

Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, 1098 Research Transition Facility, Edmonton, AB, T6G 2V2, Canada.

Robert Broad (R)

Division of Neurosurgery, Department of Surgery, University of Alberta, 2D Department of Surgery, University of Alberta Hospital, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada.

B Matt Wheatley (BM)

Division of Neurosurgery, Department of Surgery, University of Alberta, 2D Department of Surgery, University of Alberta Hospital, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada.

Tejas Sankar (T)

Division of Neurosurgery, Department of Surgery, University of Alberta, 2D Department of Surgery, University of Alberta Hospital, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada. tejas.sankar@gmail.com.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The thalamus in trigeminal neuralgia:...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Imagerie par résonance magnétique › The thalamus in trigeminal neuralgia:...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de neurochirurgie › Chirurgie de décompression microvasculaire › The thalamus in trigeminal neuralgia:...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de neurochirurgie › Dénervation › Rhizotomie › The thalamus in trigeminal neuralgia:...
questionsmedicales.fr › Système nerveux › Système nerveux central › Encéphale › Prosencéphale › Diencéphale › Thalamus › The thalamus in trigeminal neuralgia:...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › The thalamus in trigeminal neuralgia:...
questionsmedicales.fr › Maladies du système nerveux › Atteintes des nerfs crâniens › Atteintes du nerf facial › Névralgie faciale › Atteintes du nerf trijumeau › Névralgie essentielle du trijumeau › The thalamus in trigeminal neuralgia:...