The Role of Preoperative Magnetic Resonance Imaging in Assessing Neurovascular Compression Before Microvascular Decompression in Trigeminal Neuralgia.
Magnetic resonance imaging
Microvascular decompression
Neurovascular compression
Trigeminal neuralgia
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
received:
12
06
2022
revised:
18
09
2022
accepted:
19
09
2022
pubmed:
28
9
2022
medline:
21
12
2022
entrez:
27
9
2022
Statut:
ppublish
Résumé
Preoperative magnetic resonance imaging (MRI) is a standard component of the preoperative clinical workup for patients before microvascular decompression (MVD). However, its ability to accurately exclude neurovascular compression of the trigeminal nerve is not well understood. We retrospectively reviewed 1020 patients with available preoperative MRI data before microvascular decompression. General patient demographics and clinical characteristics were collected for each case. We recorded both evidence of neurovascular conflict on preoperative MRI radiology notes and intraoperative compression from operative notes. Sensitivity, specificity, positive predictive value, and negative predictive value were determined for general MRI, high-resolution MRI, and non-high resolution. Overall, preoperative MRI before MVD showed a sensitivity of 75.8%, specificity of 65.8%, positive predictive value of 92.4%, and negative predictive value of 33.3% in predicting neurovascular compression of the trigeminal nerve. In particular, MRI was unable to identify 21.0% cases of sole arterial compression, 42.5% cases of sole venous compression, and combined arterial and venous compression in 18.5% of cases. A total of 958 patients (93.9%) underwent high-resolution preoperative MRI with skull base sequences. This imaging showed a sensitivity of 75.6%, specificity of 66.9%, positive predictive value of 92.5% and a negative predictive value of 33.4% in predicting trigeminal nerve neurovascular compression. Non-high-resolution MRI showed a sensitivity of 78.8%, specificity of 50.0%, positive predictive value of 89.1%, and negative predictive value of 31.3%. The negative predictive values of general, high-resolution, and non-high-resolution MRIs were all <50%. Preoperative MRI may offer a high predictive value for neurovascular conflict and should be part of the standard preoperative care workup for patients with trigeminal neuralgia. However, lack of neurovascular conflict on preoperative imaging is not sufficient to exclude patients from undergoing MVD.
Sections du résumé
BACKGROUND
Preoperative magnetic resonance imaging (MRI) is a standard component of the preoperative clinical workup for patients before microvascular decompression (MVD). However, its ability to accurately exclude neurovascular compression of the trigeminal nerve is not well understood.
METHODS
We retrospectively reviewed 1020 patients with available preoperative MRI data before microvascular decompression. General patient demographics and clinical characteristics were collected for each case. We recorded both evidence of neurovascular conflict on preoperative MRI radiology notes and intraoperative compression from operative notes. Sensitivity, specificity, positive predictive value, and negative predictive value were determined for general MRI, high-resolution MRI, and non-high resolution.
RESULTS
Overall, preoperative MRI before MVD showed a sensitivity of 75.8%, specificity of 65.8%, positive predictive value of 92.4%, and negative predictive value of 33.3% in predicting neurovascular compression of the trigeminal nerve. In particular, MRI was unable to identify 21.0% cases of sole arterial compression, 42.5% cases of sole venous compression, and combined arterial and venous compression in 18.5% of cases. A total of 958 patients (93.9%) underwent high-resolution preoperative MRI with skull base sequences. This imaging showed a sensitivity of 75.6%, specificity of 66.9%, positive predictive value of 92.5% and a negative predictive value of 33.4% in predicting trigeminal nerve neurovascular compression. Non-high-resolution MRI showed a sensitivity of 78.8%, specificity of 50.0%, positive predictive value of 89.1%, and negative predictive value of 31.3%. The negative predictive values of general, high-resolution, and non-high-resolution MRIs were all <50%.
CONCLUSIONS
Preoperative MRI may offer a high predictive value for neurovascular conflict and should be part of the standard preoperative care workup for patients with trigeminal neuralgia. However, lack of neurovascular conflict on preoperative imaging is not sufficient to exclude patients from undergoing MVD.
Identifiants
pubmed: 36167303
pii: S1878-8750(22)01369-9
doi: 10.1016/j.wneu.2022.09.092
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e216-e222Informations de copyright
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