Radiological and Neurosurgical Diagnosis of Arterial Neurovascular Conflict on MRI for Trigeminal Neuralgia

2021 ◽  
Author(s):  
Shaani Singhal ◽  
R. Andrew Danks
Keyword(s):  
Trigeminal Neuralgia ◽  
Neurovascular Conflict

A novel scoring system as a preoperative predictor for pain-free survival after microsurgery for trigeminal neuralgia

2020 ◽  
Vol 132 (1) ◽  
pp. 217-224 ◽  
Author(s):  
Fran A. Hardaway ◽  
Hanna C. Gustafsson ◽  
Katherine Holste ◽  
Kim J. Burchiel ◽  
Ahmed M. Raslan
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Scoring System ◽  
Neurovascular Conflict ◽  
Radiographic Findings ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Mri Studies ◽  
Internal Neurolysis

OBJECTIVEPain relief following microvascular decompression (MVD) for trigeminal neuralgia (TN) may be related to pain type, degree of neurovascular conflict, arterial compression, and location of compression. The objective of this study was to construct a predictive pain-free scoring system based on clinical and radiographic factors that can be used to preoperatively prognosticate long-term outcomes for TN patients following surgical intervention (MVD or internal neurolysis [IN]). It was hypothesized that contributing factors would include pain type, presence of an artery or vein, neurovascular conflict severity, and compression location (root entry zone).METHODSAt the authors’ institution 275 patients with type 1 or type 2 TN (TN1 or TN2) underwent MVD or IN following preoperative high-resolution brain MRI studies. Outcome data were obtained retrospectively by chart review and/or phone follow-up. Characteristics of neurovascular conflict were obtained from preoperative MRI studies. Factors that resulted in a probability value of < 0.05 on univariate logistic regression analyses were entered into a multivariate Cox regression analysis in a backward stepwise fashion. For the multivariate analysis, significance at the 0.15 level was used. A prognostic system was then devised with 4 possible scores (0, 1, 2, or 3) and pain-free survival analyses conducted.RESULTSUnivariate predictors of pain-free survival were pain type (p = 0.013), presence of any vessel (p = 0.042), and neurovascular compression severity (p = 0.038). Scores of 0, 1, 2, and 3 were found to be significantly different in regard to pain-free survival (log rank, p = 0.005). At 5 and 10 years there were 36%, 43%, 61%, and 69%, and 36%, 43%, 56%, and 67% pain-free survival rates in groups 0, 1, 2, and 3, respectively. While TN2 patients had worse outcomes regardless of score, a subgroup analysis of TN1 patients with higher neurovascular conflict (score of 3) had significantly better outcomes than TN1 patients without severe neurovascular conflict (score of 1) (log rank, p = 0.005). Regardless of pain type, those patients with severe neurovascular conflict were more likely to have arterial compression (99%) compared to those with low neurovascular conflict (p < 0.001).CONCLUSIONSPain-free survival was predicted by a scoring system based on preoperative clinical and radiographic findings. Higher scores predicted significantly better pain relief than lower scores. TN1 patients with severe neurovascular conflict had the best long-term pain-free outcome.

scholarly journals To be or not to be a neurovascular conflict: importance of the preoperative identification of the neurovascular conflict in the trigeminal neuralgia

2016 ◽  
Vol 30 (3) ◽  
pp. 336-344
Author(s):  
Dana Mihaela Turliuc ◽  
B. Dobrovăţ ◽  
A. I. Cucu ◽  
Ş. Turliuc ◽  
Daniela Trandafir ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Surgical Approach ◽  
Neurovascular Compression ◽  
Neurovascular Conflict

Abstract The trigeminal neuralgia caused by neurovascular compression is a neurosurgical pathology requiring the preoperative identification as exact as possible of the neurovascular conflict. In this case, neuroimaging is very useful, as it allows not only the determination of the neurovascular conflict of the trigeminal nerve, but also the correct indication of an adequate surgical approach.

scholarly journals The role of neurovascular conflict in the pathogenesis of classical trigeminal neuralgia and the dynamics of approaches to its visualization

2021 ◽  
Vol 2 (1) ◽  
pp. 24-31
Author(s):  
E. V. Baliazina ◽  
O. M. Evusyak ◽  
V. A. Baliazin ◽  
N. G. Kadyan
Keyword(s):  
Trigeminal Neuralgia ◽  
Superior Cerebellar Artery ◽  
Neurovascular Conflict ◽  
Classical Trigeminal Neuralgia ◽  
Cerebellar Artery ◽  
X Ray Computed ◽  
Thematic Review ◽  
Points Of View ◽  
Diagnostic Capabilities

The thematic review discusses various points of view on the topographic and atomic features of the location of the root of the trigeminal nerve and the superior cerebellar artery that serve as the foundation for the development of classical trigeminal neuralgia. The diagnostic capabilities of magnetic resonance imaging in the recognition of neurovascular conflict as the pathogenetic basis of the disease are considered. The search for diagnostic criteria that distinguish neurovascular conflict from neurovascular contact by improving both the performance of MRI and the new technical possibilities of its interpretation is highlighted in the chronological aspect. The possibilities of multispiral X-ray computed angiography in 3D mode as an alternative method for diagnosing neurovascular conflict are described.

scholarly journals MICROVASCULAR DECOMPRESSION IN THE TREATMENT OF PATIENTS WITH TRIGEMINAL NEURALGIA

2019 ◽  
Vol 19 (1-2) ◽  
pp. 101-106
Author(s):  
D. M Lazarchuk ◽  
G. N Alekseev ◽  
O. O Kamadey ◽  
S. N Chemidronov
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Nerve Root ◽  
Treatment Method ◽  
Neurovascular Conflict ◽  
Neurosurgical Department ◽  
Trigeminal Nerve Root ◽  
Trigeminal Root ◽  
Cranial Fossa

This work highlights the main variant treatment of patients with trigeminal neuralgia, with a proven neurovascular conflict, microvascular decompression of the trigeminal root. Microvascular decompression is the main radical treatment method which allows to relieve hyperfunctional syndrome manifested by prosopalgia. In the course of this study, the variant anatomy of the neurovascular conflict in patients with trigeminal neuralgia was described in detail. The group of patients whose clinical diagnosis at the stage of selection was based on a neurological examination and taking into account the progression of symptoms as well as the performed instrumental examination (CT angiography). The results are described in the article. Atrophic changes of the root of the trigeminal nerve are visualized and described. The nature of its blood supply is classified according to the type of the origin of the artery or arterial branches of the trigeminal nerve root. The main types of neurovascular conflict classified according to the type of blood vessel are presented. Variant neuroanatomy of the trigeminal nerve root as well as the interaction with the arteries of the vertebrobasilar basin and the veins of the posterior cranial fossa are described. The course of microvascular decompression of the trigeminal nerve root, used in the neurosurgical department of Samara Regional Clinical Hospital n.a. V.D. Seredavin is described

scholarly journals Correlation of Trigeminopontine Angle with Severity of Trigeminal Neuralgia due to Neurovascular conflict over medial aspect of nerve. Can we prognosticate the reduction in pain in patients on medical management?

2021 ◽  
Author(s):  
Pundalik Umalappa Lamani ◽  
Abhishek J Arora ◽  
Kiran Kumar Reddy Kona ◽  
Jyotsna Yarlagadda
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Medical Management ◽  
Rating Scale ◽  
Treatment Plan ◽  
Statistical Significance ◽  
Poor Response ◽  
Post Treatment ◽  
Medial Aspect ◽  
Neurovascular Conflict

Abstract Background: Neurovascular conflicts (NVC) are one of the major causative factors in patients presenting with Trigeminal neuralgia (TN). We found great degree of variation in acuteness of medial trigeminopontine angle (mTPA), angle between medial border of trigeminal nerve and anterior border of pons in patients with TN and tried to find its correlation with pain severity due to NVC over the medial aspect of nerve (mNVC).Aims and Objectives: To Correlate mTPA measurement with severity of trigeminal neuralgia due to mNVC. To calculate the reduction in pain in patients kept on medical management and its correlation with medial trigeminopontine angle.Material and Methods: This was a retrospective observational study conducted between May 2018 to October 2020. A total of 41 patients presenting with Trigeminal Neuralgia and showing corresponding Neurovascular conflict were included in the study. Out of the total cases with NVC, 30 cases showed NVC over the medial surface of the nerve. All the patients were evaluated on MAGNETOM Skyra 3T MRI (Siemens). Using Two-line Cobb angle method, trigeminopontine angle was calculated. Pre-treatment pain intensity and post treatment pain relief of each patients were assessed by using numeric rating scale (NRS). NRS with numbers from 0 to 10 (‘no pain’ to ‘worst pain imaginable’). Relevant clinical details regarding pre- and post-treatment pain score as well as treatment plan opted by patients were collected.Results: Patients with post treatment response ≥ 50% is considered as “good response” and < 50% is considered as “poor response”. In our study with trigeminopontine angle threshold of 45 degree, 7 out of 8 (87.5%) patients with > 450 mTPA showed poor response and 15/22 (68.2%) patients ≤ 450 showed good response to medical management for trigeminal neuralgia due to mNVC with statistical significance difference with p-valve of 0.007Conclusion: In our study, we found a negative correlation between the mTPA and percentage pain relief in patients kept on medical management. We realised that mTPA measurement could become an important tool for prognosticating pain relief for patients of trigeminal neuralgia on medical therapy.

scholarly journals Microvascular decompression in trigeminal neuralgia: predictors of pain relief, complication avoidance, and lessons learned

2021 ◽  
Author(s):  
Johannes Herta ◽  
Tobias Schmied ◽  
Theresa Bettina Loidl ◽  
Wei-te Wang ◽  
Wolfgang Marik ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
The Elderly ◽  
Pain Intensity Score ◽  
Complication Rates ◽  
Safe Procedure ◽  
Neurovascular Conflict ◽  
Paroxysmal Pain

Abstract Objective To analyze characteristics associated with long-term pain relief after microvascular decompression (MVD) for trigeminal neuralgia (TGN). Description of associated morbidity and complication avoidance. Methods One hundred sixty-five patients with TGN underwent 171 MVD surgeries at the authors’ institution. Patient characteristics and magnetic resonance imaging (MRI) datasets were obtained through the hospital’s archiving system. Patients provided information about pre- and post-operative pain characteristics and neurologic outcome. Favorable outcome was defined as a Barrow Neurological Institute (BNI) pain intensity score of I to III with post-operative improvement of I grade. Results Type of TGN pain with purely paroxysmal pain (p = 0.0202*) and TGN classification with classical TGN (p = 0.0372*) were the only significant predictors for long-term pain relief. Immediate pain relief occurred in 90.6% of patients with a recurrence rate of 39.4% after 3.5 ± 4.6 years. MRI reporting of a neurovascular conflict had a low negative predictive value of 39.6%. Mortality was 0% with major complications observed in 8.2% of patients. Older age was associated with lower complication rates (p = 0.0009***). Re-MVD surgeries showed improved long-term pain relief in four out of five cases. Conclusions MVD is a safe and effective procedure even in the elderly. It has the unique potential to cure TGN if performed on a regular basis, and if key surgical steps are respected. Early MVD should be offered in case of medical treatment failure and paroxysmal pain symptoms. The presence of a neurovascular conflict on MRI is not mandatory. In case of recurrence, re-MVD is a good treatment option that should be discussed with patients. Highlights • Long-term analysis of pain relief after MVD. • Positive predictors for outcome: classical TGN and purely paroxysmal pain. • Presence of neurovascular conflict in MRI is not mandatory for MVD surgery. • Analysis of complications and surgical nuances for avoidance. • MVD is a safe procedure also in the elderly.

COMPLEX DIAGNOSTICS OF NEUROVASCULAR CONFLICT IN PATIENTS WITH CLASSIC TRIGEMINAL NEURALGIA

2020 ◽  
Vol 1 (1) ◽  
pp. 70-77
Author(s):  
E. V. Baliazina ◽  
O. I. Bondareva ◽  
V. A. Baliazin ◽  
O. M. Evusiak
Keyword(s):  
Trigeminal Neuralgia ◽  
Neurovascular Conflict
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