title: Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes.
abstract: OBJECTIVE
  The aim of this study was to prospectively evaluate atrophic changes in trigeminal nerves (TGNs) using measurements of volume (V) and cross-sectional area (CSA) from high-resolution 3-T MR images obtained in patients with unilateral trigeminal neuralgia (TN), and to correlate these data with patient and neurovascular compression (NVC) characteristics and with clinical outcomes.
  
  
  METHODS
  Anatomical TGN parameters (V and CSA) were obtained in 50 patients (30 women and 20 men; mean age 56.42 years, range 22-79 years) with classic TN before treatment with microvascular decompression (MVD). Parameters were compared between the symptomatic (ipsilateralTN) and asymptomatic (contralateralTN) sides of the face. Twenty normal control subjects were also included. Two independent observers blinded to the side of pain separately analyzed the images. Measurements of V (from the pons to the entrance of the nerve into Meckel's cave) and CSA (at 5 mm from the entry of the TGN into the pons) for each TGN were performed using imaging software and axial and coronal projections, respectively. These data were correlated with patient characteristics (age, duration of symptoms before MVD, side of pain, sex, and area of pain distribution), NVC characteristics (type of vessel involved in NVC, location of compression along the nerve, site of compression around the circumference of the root, and degree of compression), and clinical outcomes at the 2-year follow-up after surgery. Comparisons were made using Bonferroni's test. Interobserver variability was assessed using the Pearson correlation coefficient.
  
  
  RESULTS
  The mean V of the TGN on the ipsilateralTN (60.35 ± 21.74 mm(3)) was significantly smaller (p < 0.05) than those for the contralateralTN and controls (78.62 ± 24.62 mm(3) and 89.09 ± 14.72 mm(3), respectively). The mean CSA of the TGN on the ipsilateralTN (4.17 ± 1.74 mm(2)) was significantly smaller than those for the contralateralTN and controls (5.41 ± 1.89 mm(2) and 5.64 ± 0.85 mm(2), respectively). The ipsilateralTN with NVC Grade III (marked indentation) had a significantly smaller mean V than the ipsilateralTN with NVC Grade I (mere contact), although it was not significantly smaller than that of the ipsilateralTN with NVC Grade II (displacement or distortion of root). The ipsilateralTN with NVC Grade III had a significantly smaller mean CSA than the ipsilateralTN with NVC Grades I and II (p < 0.05). The TGN on the ipsilateralTN in cured patients had a smaller mean CSA than that on the ipsilateralTN of patients with partial pain relief or treatment failure (p < 0.05). The same finding was almost found in relation to measurements of V, but the p value was slightly higher at 0.05.
  
  
  CONCLUSIONS
  Results showed that TGN atrophy in patients with TN can be demonstrated by high-resolution imaging. These data suggest that atrophic changes in TGNs, which significantly correlated with the severity of compression and clinical outcomes, may help to predict long-term prognosis after vascular decompression.
authors.affiliation: Departments of Neurosurgery and.
authors.forename: Paulo Roberto Lacerda
authors.initials: PR
authors.lastname: Leal
authors.forename: Charlotte
authors.initials: C
authors.lastname: Barbier
authors.forename: Marc
authors.initials: M
authors.lastname: Hermier
authors.forename: Miguel Angelo
authors.initials: MA
authors.lastname: Souza
authors.forename: Gerardo
authors.initials: G
authors.lastname: Cristino-Filho
authors.forename: Marc
authors.initials: M
authors.lastname: Sindou
mesh_terms: D000328:Adult; D000368:Aged; D001176:Arthrogryposis / Q000150:complications*; D001284:Atrophy; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D015417:Hereditary Sensory and Motor Neuropathy / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010147:Pain Measurement; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014276:Trigeminal Nerve / Q000473:pathology*; D014277:Trigeminal Neuralgia / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology*
keywords: AICA = anterior inferior cerebellar artery; BA = basilar artery; CSA = cross-sectional area; DRIVE = driven equilibrium; INF = inferior; JP = juxtapetrous segment; MC = midcisternal; MPR = multiplanar reformation; MVD = microvascular decompression; NVC = neurovascular compression; SCA = superior cerebellar artery; SL = superolateral; SM = superomedial; SPV = superior petrosal vein; TGN = trigeminal nerve; TN = trigeminal neuralgia; TOF-MRA = time-of-flight MR angiography; TPV = transverse pontine vein; TREZ = trigeminal root entry zone; V = volume; contralateralTN = side of face unaffected by TN; cross-sectional area; ipsilateralTN = side of face affected by TN; microvascular decompression; neurovascular compression; pain; three-dimensional imaging; trigeminal neuralgia; volume