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Nerve atrophy in trigeminal neuralgia due to neurovascular compression and its association with surgical outcomes after microvascular decompression

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Abstract

Background

Idiopathic trigeminal neuralgia (TN) is caused by neurovascular compression and is often related to morphological changes in the trigeminal nerve. The aim of this study was to quantitatively measure atrophic changes of trigeminal nerves in patients with TN, and to further investigate whether nerve atrophy affected the efficacy of microvascular decompression (MVD).

Methods

We conducted a prospective case-control study of 60 consecutive patients with TN and 30 sex- and age-matched healthy controls. All subjects underwent high-resolution three-dimensional MRI. The volume of the cisternal segment of trigeminal nerves was measured and compared using 3D Slicer software. Patients with TN underwent primary MVD and regular follow-up for at least 2 years. Associations of nerve atrophy with patient characteristics and operative outcomes were analyzed.

Results

The mean volume of the affected trigeminal nerve was significantly reduced in comparison to that of the nonaffected side (65.8 ± 21.1 versus 77.9 ± 19.3 mm3, P = 0.001) and controls (65.8 ± 21.1 versus 74.7 ± 16.5 mm3, P = 0.003). Fifty-two patients (86.7%) achieved complete pain relief without medication immediately after surgery, and 77.6% of patients were complete pain relief at the 2-year follow-up. The Spearman correlation test showed that there was a positive correlation (r = 0.46, P = 0.018) between the degree of trigeminal nerve indentation and nerve atrophy. In multivariate logistic regression analysis, two factors, indentation on nerve root (OR = 2.968, P = 0.022) and degree of nerve atrophy (OR = 1.18, P = 0.035), were associated with the long-term outcome.

Conclusions

TN is associated with atrophy on the affected nerve. Furthermore, greater nerve atrophy is associated with more severe trigeminal nerve indentation and better long-term outcome following MVD.

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Abbreviations

TN:

Trigeminal neuralgia

MVD:

Microvascular decompression

NVC:

Neurovascular conflict

REZ:

Root entry zone

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Author notes

  1. Jian Cheng and Jinli Meng contributed equally to the study as the co-first authors.

Authors and Affiliations

  1. Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, People’s Republic of China

    Jian Cheng, Wenke Liu, Heng Zhang, Xuhui Hui & Ding Lei

  2. Department of Radiology, Hospital of Chengdu office of People’s Government of Tibetan Autonomous Region (Hospital. C.T), Chengdu, China

    Jinli Meng

Authors
  1. Jian Cheng
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  2. Jinli Meng
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  3. Wenke Liu
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  4. Heng Zhang
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  5. Xuhui Hui
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  6. Ding Lei
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Corresponding author

Correspondence to Ding Lei.

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Funding

This work was supported by Sichuan Science and Technology Support Program (No. 2015SZ0188).

Conflict of interest

None.

Ethical approval

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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Cheng, J., Meng, J., Liu, W. et al. Nerve atrophy in trigeminal neuralgia due to neurovascular compression and its association with surgical outcomes after microvascular decompression. Acta Neurochir 159, 1699–1705 (2017). https://doi.org/10.1007/s00701-017-3250-9

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  • DOI: https://doi.org/10.1007/s00701-017-3250-9

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