The Sagittal Angle of the Trigeminal Nerve at the Porus Trigeminus is a Radiologic Predictor of Surgical Outcome in Microvascular Decompression for Classical Trigeminal Neuralgia.
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
14 Sep 2023
14 Sep 2023
Historique:
received:
13
04
2023
accepted:
11
07
2023
medline:
14
9
2023
pubmed:
14
9
2023
entrez:
14
9
2023
Statut:
aheadofprint
Résumé
Classical trigeminal neuralgia (cTN) is a painful disease. Microvascular decompression (MVD) provides immediate and durable relief in many patients. A variety of positive and negative prognostic biomarkers for MVD have been identified. The sagittal angle of the trigeminal nerve at the porus trigeminus (SATNaPT) is an MRI biomarker that can identify a subset of patients with cTN whose trigeminal nerve anatomy is different from normal controls. The purpose of this case-control study was to determine whether an abnormally hyperacute SATNaPT is a negative prognostic biomarker in patients with cTN undergoing MVD. Preoperative MRIs from 300 patients with cTN who underwent MVD were analyzed to identify patients with a hyperacute SATNaPT (defined as less than 3 SDs below the mean). The rate of surgical success (pain-free after at least 12 months) was compared between patients with a hyperacute SATNaPT and all other patients. Patients without a hyperacute SATNaPT had an 82% likelihood of surgical success, whereas patients with a hyperacute SATNaPT had a 58% likelihood of surgical success (P < .05). Patients with a hyperacute SATNaPT who also had no evidence of vascular compression on preoperative MRI had an even lower likelihood of success (29%, P < .05). In patients with cTN being considered for MVD, a hyperacute SATNaPT is a negative prognostic biomarker that predicts a higher likelihood of surgical failure. Patients with a hyperacute SATNaPT, particularly those without MRI evidence of vascular compression, may benefit from other surgical treatments or a modification of MVD to adequately address the underlying cause of cTN.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Classical trigeminal neuralgia (cTN) is a painful disease. Microvascular decompression (MVD) provides immediate and durable relief in many patients. A variety of positive and negative prognostic biomarkers for MVD have been identified. The sagittal angle of the trigeminal nerve at the porus trigeminus (SATNaPT) is an MRI biomarker that can identify a subset of patients with cTN whose trigeminal nerve anatomy is different from normal controls. The purpose of this case-control study was to determine whether an abnormally hyperacute SATNaPT is a negative prognostic biomarker in patients with cTN undergoing MVD.
METHODS
METHODS
Preoperative MRIs from 300 patients with cTN who underwent MVD were analyzed to identify patients with a hyperacute SATNaPT (defined as less than 3 SDs below the mean). The rate of surgical success (pain-free after at least 12 months) was compared between patients with a hyperacute SATNaPT and all other patients.
RESULTS
RESULTS
Patients without a hyperacute SATNaPT had an 82% likelihood of surgical success, whereas patients with a hyperacute SATNaPT had a 58% likelihood of surgical success (P < .05). Patients with a hyperacute SATNaPT who also had no evidence of vascular compression on preoperative MRI had an even lower likelihood of success (29%, P < .05).
CONCLUSION
CONCLUSIONS
In patients with cTN being considered for MVD, a hyperacute SATNaPT is a negative prognostic biomarker that predicts a higher likelihood of surgical failure. Patients with a hyperacute SATNaPT, particularly those without MRI evidence of vascular compression, may benefit from other surgical treatments or a modification of MVD to adequately address the underlying cause of cTN.
Identifiants
pubmed: 37706752
doi: 10.1227/neu.0000000000002671
pii: 00006123-990000000-00887
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © Congress of Neurological Surgeons 2023. All rights reserved.
Références
International Headache Society. International Classification of Headache Disorders-3. Accessed December 5, 2022. https://ichd-3.org/13-painful-cranial-neuropathies-and-other-facial-pains/13-1-trigeminal-neuralgia/.
Sheth S, Branstetter BF 4th, Escott EJ. Appearance of normal cranial nerves on steady-state free precession MR images. Radiographics. 2009;29(4):1045-1055. Erratum in: Radiographics. 2009;29(5):1544.
Jawahar A, Kondziolka D, Kanal E, Bissonette DJ, Lunsford LD. Imaging the trigeminal nerve and pons before and after surgical intervention for trigeminal neuralgia. Neurosurgery. 2001;48(1):101-107.
Hughes MA, Frederickson AM, Branstetter BF, Zhu X, Sekula RF Jr. MRI of the trigeminal nerve in patients with trigeminal neuralgia secondary to vascular compression. Am J Roentgenol. 2016;206(3):595-600.
Brinzeu A, Drogba L, Sindou M. Reliability of MRI for predicting characteristics of neurovascular conflicts in trigeminal neuralgia: implications for surgical decision making. J Neurosurg. Published online April 1, 2018. doi: 10.3171/2017.8.JNS171222.
doi: 10.3171/2017.8.JNS171222
Duan Y, Sweet J, Munyon C, Miller J. Degree of distal trigeminal nerve atrophy predicts outcome after microvascular decompression for Type 1a trigeminal neuralgia. J Neurosurg. 2015;123(6):1512-1518.
Sekula R, Mousavi S, Gildengers A, Gardner P, Lunsford LD. Concomitant depression and anxiety negatively affect pain outcomes in surgically managed young patients with trigeminal neuralgia: long-term clinical outcome. Surg Neurol Int. 2016;7(1):98.
Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334(17):1077-1084.
Tyler-Kabara EC, Kassam AB, Horowitz MH, et al. Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression. J Neurosurg. 2002;96(3):527-531.
Sindou M, Leston J, Decullier E, Chapuis F. Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg. 2007;107(6):1144-1153.
Branstetter BF, Reddy N, Patel K, Sekula RF. Sagittal angle of the trigeminal nerve at the porus trigeminus: a novel measurement to distinguish different causes of classic trigeminal neuralgia. AJNR Am J Neuroradiol. 2022;43(10):1460-1463.
Hughes MA, Jani RH, Fakhran S, et al. Significance of degree of neurovascular compression in surgery for trigeminal neuralgia. J Neurosurg. Published online June 14, 2019. doi: 10.3171/2019.3.JNS183174.
doi: 10.3171/2019.3.JNS183174
Brinzeu A, Dumot C, Sindou M. Role of the petrous ridge and angulation of the trigeminal nerve in the pathogenesis of trigeminal neuralgia, with implications for microvascular decompression. Acta Neurochir (Wien). 2018;160(5):971-976.
Mazzucchi E, Brinzeu A, Sindou M. Arachnoiditis as an outcome factor for microvascular decompression in classical trigeminal neuralgia. Acta Neurochir. 2019;161(8):1589-1598.