The role of preoperative MRI imaging in assessing neurovascular compression prior to microvascular decompression in trigeminal neuralgia. World neurosurgery Xu, R., Nair, S. K., Raj, D., Materi, J., So, R. J., Gujar, S. K., Huang, J., Blitz, A. M., Lim, M., Sair, H. I., Bettegowda, C. 2022


Preoperative MRI is a standard component of the preoperative clinical workup for patients prior to 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 prior to 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 was determined for general MRI, high-resolution MRI, and non-high resolution.Overall, preoperative MRI prior to MVD demonstrated 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. 958 (93.9%) patients underwent high-resolution preoperative MRI with skull base sequences. This exhibited 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. Finally, 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%. Importantly, the negative predictive values of general, high resolution, and non-high resolution MRIs were all below 50%.Preoperative MRI may offer a high predictive value for neurovascular conflict and should be part of the standard preoperative care workup for trigeminal neuralgia patients. However, lack of neurovascular conflict on preoperative imaging is not sufficient to exclude patients from undergoing MVD.

View details for DOI 10.1016/j.wneu.2022.09.092

View details for PubMedID 36167303