title: Pre-operative declining proportion of fractional anisotropy of trigeminal nerve is correlated with the outcome of micro-vascular decompression surgery.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Neurosurgery Department, Guangzhou First People's Hospital Guangzhou Medical University, Guangzhou, 510180, People's Republic of China.
authors.forename: Fanfan
authors.initials: F
authors.lastname: Chen
authors.affiliation: Neurosurgery Department, Shenzhen Second People' s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, People's Republic of China.
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.affiliation: 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.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: Recorder Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, People's Republic of China.
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.affiliation: Radiology Department, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, People's Republic of China.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Xu
authors.affiliation: Neurosurgery Department, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, 130021, People's Republic of China.
authors.forename: Weimin
authors.initials: W
authors.lastname: Li
authors.affiliation: Neurosurgery Department, Guangzhou First People's Hospital Guangzhou Medical University, Guangzhou, 510180, People's Republic of China.
authors.forename: Wuhua
authors.initials: W
authors.lastname: Le
authors.affiliation: Neurosurgery Department, Guangzhou First People's Hospital Guangzhou Medical University, Guangzhou, 510180, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Xie
authors.affiliation: Department of Neurosurgery, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, 200003, People's Republic of China. panda1979hh@sina.com.
authors.forename: Hua
authors.initials: H
authors.lastname: He
authors.affiliation: Neurosurgery Department, Guangzhou First People's Hospital Guangzhou Medical University, Guangzhou, 510180, People's Republic of China. corarticle@126.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016880:Anisotropy; D019299:Decompression, Surgical / Q000379:methods*; D056324:Diffusion Tensor Imaging / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014276:Trigeminal Nerve / Q000473:pathology*; D014277:Trigeminal Neuralgia / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Magnetic resonance imaging; Neurovascular compression; Trigeminal neuralgia; Type 2 trigeminal neuralgia