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BMC Neurol. 2016 Jul 16;16:106. doi: 10.1186/s12883-016-0620-5.

Pre-operative declining proportion of fractional anisotropy of trigeminal nerve is correlated with the outcome of micro-vascular decompression surgery.

Author information

1
Neurosurgery Department, Guangzhou First People's Hospital Guangzhou Medical University, Guangzhou, 510180, People's Republic of China.
2
Neurosurgery Department, Shenzhen Second People' s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, People's Republic of China.
3
Institutes of Brain Science, State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, 200032, People's Republic of China.
4
Recorder Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, People's Republic of China.
5
Radiology Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, People's Republic of China.
6
Neurosurgery Department, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, 130021, People's Republic of China.
7
Department of Neurosurgery, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, 200003, People's Republic of China. panda1979hh@sina.com.
8
Neurosurgery Department, Guangzhou First People's Hospital Guangzhou Medical University, Guangzhou, 510180, People's Republic of China. corarticle@126.com.

Abstract

BACKGROUND:

Type 2 trigeminal neuralgia (TN) is an intractable neuropathic pain syndrome compared with type 1 TN because of the difficulty of diagnosis as well as the unsatisfactory prognosis. Neurovascular compression (NVC) is considered the major pathology of TN. Routine magnetic resonance imaging (MRI) sequences are inadequate for revealing the effect of NVC which is related to the surgical decision and outcome. The decreasing of fractional anisotropy (FA), one of the MRI diffusion tensor imaging (DTI) metrics, is correlated with the demyelination of trigeminal nerve (TGN) that reveal the severity of NVC.

METHODS:

A retrospective review of patients treated with micro-vascular decompression (MVD) surgery was undertaken. All the patients were diagnosed as type 2 TN. FA of TGN of both sides were measured. The FA declining proportion = ((the mean FA value of healthy lateral)-(the mean FA value of the symptomatic lateral))/(the mean FA value of healthy lateral). Declining proportion of FA value, discovery of surgery and outcome of MVD were recorded and analyzed. Logistic regression analysis and linear regression analysis were employed to analyze the risk factors of declining proportion of FA value and MVD outcome.

RESULTS:

Nineteen patients were assessed in our study. The average declining proportion of FA value for all patients was 0.25 ± 0.12. The average declining proportion of FA value of "success" and "failure" group was 0.32 ± 0.09 to 0.14 ± 0.10 (P = 0.002 < 0.05). The declining proportion of FA value of artery (including the artery plus vein situation) was 0.34 ± 0.06 in contrast to 0.15 ± 0.08 of vein (P = 0.000 < 0.05). MVD outcome was correlated with declining proportion of FA value (AUC = 0.900). Furthermore, declining proportion of FA value was higher in arterial compression situation.

CONCLUSION:

FA value quantitatively showed the alteration of TGN caused by NVC. It provided direct evidence about the effect of NVC which facilitated the diagnosis and surgical decision of type 2 TN. Besides, significant reduction of FA value may predict an optimistic outcome of MVD.

KEYWORDS:

Magnetic resonance imaging; Neurovascular compression; Trigeminal neuralgia; Type 2 trigeminal neuralgia

PMID:
27422267
PMCID:
PMC4947245
DOI:
10.1186/s12883-016-0620-5
[Indexed for MEDLINE]
Free PMC Article

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