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Diffusion tensor imaging abnormalities of the trigeminal nerve root in patients with classical trigeminal neuralgia: a pre- and postoperative comparative study 4 years after microvascular decompression

  • Original Article - Functional Neurosurgery - Pain
  • Published:
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Abstract

Background

As diffusion tensor imaging (DTI) is able to assess tissue integrity, authors used diffusion to detect abnormalities in trigeminal nerves (TGN) in patients with trigeminal neuralgia (TN) caused by neurovascular compression (NVC) who had undergone microvascular decompression (MVD). The authors also studied anatomical TGN parameters (cross-sectional area [CSA] and volume [V]). The study compared pre- and postoperative findings.

Methods

Using DTI sequencing on a 3-T MRI scanner, we measured the fraction of anisotropy (FA) and apparent diffusion coefficient (ADC) of the TGN in 10 patients who had undergone MVD for TN and in 6 normal subjects. We compared data between affected and unaffected nerves in patients and both nerves in normal subjects (controls). We then correlated these data with CSA and V. Data from the affected side and the unaffected side before and 4 years after MVD were compared.

Results

Before MVD, the FA of the affected side (0.37 ± 0.03) was significantly lower (p < 0.05) compared to the unaffected side in patients (0.48 ± 0.03) and controls (0.52 ± 0.02), and the ADC in the affected side (5.6 ± 0.34 mm2/s) was significantly higher (p < 0.05) compared to the unaffected side in patients (4.26 ± 0.25 mm2/s) and controls (3.84 ± 0.18 mm2/s). Affected nerves had smaller V and CSA compared to unaffected nerves and controls (p < 0.05). After MVD, the FA in the affected side (0.41 ± 0.02) remained significantly lower (p < 0.05) compared to the unaffected side (0.51 ± 0.02), but the ADC in the affected side (4.24 ± 0.34 mm2/s) had become similar (p > 0.05) to the unaffected side (4.01 ± 0.33 mm2/s).

Conclusions

DTI revealed a loss of anisotropy and an increase in diffusivity in affected nerves before surgery. Diffusion alterations correlated with atrophic changes in patients with TN caused by NVC. After removal of the compression, the loss of FA remained, but ADC normalized in the affected nerves, suggesting improvement in the diffusion of the trigeminal root.

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Acknowledgments

We are grateful to Ms. Valérie Constans for linguistic editing assistance.

Funding

No funding was received for this research.

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Authors and Affiliations

  1. University of Lyon 1, Lyon, France

    Paulo Roberto Lacerda Leal & Marc Sindou

  2. Department of Neurosurgery, School of Medicine, Federal University of Ceará, 100, Avenida Comandante Maurocelio Rocha Pontes, Sobral, 62042-280, Brazil

    Paulo Roberto Lacerda Leal

  3. Department of Neuroradiology, University of Lyon 1, Lyon, France

    Jean Roch, Marc Hermier & Yves Berthezene

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  1. Paulo Roberto Lacerda Leal
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Contributions

PRLL participated in the acquisition of data and design of the clinical protocol, drafted the ethics applications and regulatory submissions, interpreted the data, and wrote the manuscript. JAR, MH, and YB participated in the acquisition of data. MS participated in the interpretation of data, coordinated the selection of patients, drafted the ethics applications and regulatory submissions, interpreted the data, and wrote the manuscript.

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Correspondence to Paulo Roberto Lacerda Leal.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interests in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Leal, P.R.L., Roch, J., Hermier, M. et al. Diffusion tensor imaging abnormalities of the trigeminal nerve root in patients with classical trigeminal neuralgia: a pre- and postoperative comparative study 4 years after microvascular decompression. Acta Neurochir 161, 1415–1425 (2019). https://doi.org/10.1007/s00701-019-03913-5

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