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Meta-Analysis
. 2014 Aug;155(8):1464-1471.
doi: 10.1016/j.pain.2014.04.020. Epub 2014 Apr 28.

Magnetic resonance imaging contribution for diagnosing symptomatic neurovascular contact in classical trigeminal neuralgia: a blinded case-control study and meta-analysis

Giovanni Antonini  1 , Antonella Di Pasquale, Giorgio Cruccu, Andrea Truini, Stefania Morino, Giorgia Saltelli, Andrea Romano, Guido Trasimeni, Nicola Vanacore, Alessandro Bozzao
Affiliations
Meta-Analysis

Magnetic resonance imaging contribution for diagnosing symptomatic neurovascular contact in classical trigeminal neuralgia: a blinded case-control study and meta-analysis

Giovanni Antonini et al. Pain. 2014 Aug.

Abstract

Although classical trigeminal neuralgia (CTN) is frequently caused by neurovascular contact (NVC) at the trigeminal root entry zone (REZ), both anatomical and MRI studies have shown that NVC of the trigeminal nerve frequently occurs in individuals without CTN. To assess the accuracy of MRI in distinguishing symptomatic from asymptomatic trigeminal NVC, we submitted to high-definition MRI the series of CTN patients referred to our outpatient service between June 2011 and January 2013 (n=24), and a similar number of age-matched healthy controls. Two neuroradiologists, blinded to the clinical data, evaluated whether the trigeminal nerve displayed NVC in the REZ or non-REZ, whether it was dislocated by the vessel or displayed atrophy at the contact site, and whether the offending vessel was an artery or a vein. Our data were meta-analyzed with those of all similar studies published from January 1970 to June 2013. In our sample, REZ contact, nerve dislocation and nerve atrophy were independently associated with CTN (P=.027; P=.005; P=.035 respectively). Compared to a rather low sensitivity of each of these items (alone or in combination), their specificity was high. When REZ contact and nerve atrophy coexisted, both specificity and positive predictive value rose to 100%. Meta-analysis showed that REZ NVC was detected in 76% of symptomatic and 17% of asymptomatic nerves (P<.0001), whereas anatomical changes were detected in 52% of symptomatic and 9% of asymptomatic nerves (P<.0001). In conclusion, trigeminal REZ NVC, as detected by MRI, is highly likely to be symptomatic when it is associated with anatomical nerve changes.

Keywords: Classical trigeminal neuralgia; Magnetic resonance imaging; Meta-analysis; Neurovascular contact; Systematic review.

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References

    1. Akimoto H, Nagaoka T, Nariai T, Takada Y, Ohno K, Yoshino N. Preoperative evaluation of neurovascular compression in patients with trigeminal neuralgia by use of three-dimensional reconstruction from two types of high-resolution magnetic resonance imaging. Neurosurgery 2002;51:956-961.
    1. Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 1996;334:1077-1083.
    1. Benes L, Shiratori K, Gurschi M, Sure U, Tirakotai W, Krischek B, Bertalanffy H. Is preoperative high-resolution magnetic resonance imaging accurate in predicting neurovascular compression in patients with trigeminal neuralgia? A single-blind study. Neurosurg Rev 2005;28:131-136.
    1. Boecher-Schwarz HG, Bruehl K, Kessel G, Guenthner M, Perneczky A, Stoeter P. Sensitivity and specificity of MRA in the diagnosis of neurovascular compression in patients with trigeminal neuralgia. A correlation of MRA and surgical findings. Neuroradiology 1998;40:88-95.
    1. Cha J, Kim ST, Kim HJ, Choi JW, Kim HJ, Jeon P, Kim KH, Byunand HS, Park K. Trigeminal neuralgia: assessment with T2 VISTA and FLAIR VISTA fusion imaging. Eur Radiol 2011;21:2633-2639.