Predicting Outcomes in Patients with Trigeminal Neuralgia: Pre-Operative FIESTA MRI and Microvascular DecompressionKeywords: trigeminal neuralgia, pain, microvascular decompression, outcome, ImagingInteractive Manuscript
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What is the background behind your study?
Trigeminal neuralgia (TN) is a disorder characterized by intense facial pain in areas innervated by the trigeminal nerve. Reports indicate that 80-90% of cases are caused by microvascular compression (MC). Recent improvements in MRI resolution have provided visualization of potential compressing vessels.
What is the purpose of your study?
We evaluate the efficacy of pre-operative MRI in predicting post-operative outcome.
Describe your patient group.
We collected all available MRIs of patients that underwent a microvascular decompression (MVD) surgery in the past 5 to 10 years at a large academic hospital.
Describe what you did.
We limited our sample to patients with a pre-operative MRI utilizing fast imaging with steady-state acquisition (FIESTA). An experienced neurosurgeon retrospectively reviewed the MRIs of each patient while blinded to patient identity, symptomatology, and outcome. The reviewer classified the degree and locus of trigeminal compression bilaterally. These results were compared to retrospective data on post-operative outcome. A Fisher''s Exact Test for binomial proportion was used to evaluate the results.
Describe your main findings.
We reviewed 47 patients that received high resolution MRI imaging prior to MVD surgery. Of these, 17 were found on review to have significant compression at the root entry zone of the symptomatic nerve. Fifteen of these patients experienced complete pain relief versus complete relief in 19/30 that had no such evidence of compression (Fisher''s Exact Test p=0.09).
Describe the main limitation of this study.
This is a retrospective
Describe your main conclusion.
These data suggest that pre-operative MRI may predict success in patients undergoing MVD surgery.
Describe the importance of your findings and how they can be used by others.
Our future study will explore the value of hi-resolution MRI in predicting long-term outcome for various treatments of TN using a larger sample size.
Trigeminal neuralgia (TN) is a disorder characterized by intense facial pain in areas innervated by the trigeminal nerve. Reports indicate that 80-90% of cases are caused by microvascular compression (MC). Recent improvements in MRI resolution have provided visualization of potential compressing vessels.
We evaluate the efficacy of pre-operative MRI in predicting post-operative outcome.
We collected all available MRIs of patients that underwent a microvascular decompression (MVD) surgery in the past 5 to 10 years at a large academic hospital.
We limited our sample to patients with a pre-operative MRI utilizing fast imaging with steady-state acquisition (FIESTA). An experienced neurosurgeon retrospectively reviewed the MRIs of each patient while blinded to patient identity, symptomatology, and outcome. The reviewer classified the degree and locus of trigeminal compression bilaterally. These results were compared to retrospective data on post-operative outcome. A Fisher''s Exact Test for binomial proportion was used to evaluate the results.
We reviewed 47 patients that received high resolution MRI imaging prior to MVD surgery. Of these, 17 were found on review to have significant compression at the root entry zone of the symptomatic nerve. Fifteen of these patients experienced complete pain relief versus complete relief in 19/30 that had no such evidence of compression (Fisher''s Exact Test p=0.09).
This is a retrospective
These data suggest that pre-operative MRI may predict success in patients undergoing MVD surgery.
Our future study will explore the value of hi-resolution MRI in predicting long-term outcome for various treatments of TN using a larger sample size.
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