title: Neurovascular Compression at the Root Entry Zone Correlates with Trigeminal Neuralgia and Early Microvascular Decompression Outcome.
abstract: BACKGROUND
  Trigeminal neurovascular contact (NVC) is hypothesized to be the etiology of classical trigeminal neuralgia (TGN). We aimed to seek a correlation between types of NVCs and the presence of TGN as well as early surgical outcome in patients with TGN treated with trigeminal microvascular decompression (MVD).
  
  
  METHODS
  We blindly analyzed preoperative high-resolution magnetic resonance images with respect to the degree (none, "touch," or compression) and location of bilateral NVC in 57 retrospectively identified Burchiel Type 1 TGN patients treated by MVD. Location of NVC was noted as either at the root entry zone or distal to it. Using a logistic regression model, we assessed the degree and location of trigeminal NVC for correlation with the symptomatic side. Furthermore, the NVC characteristics on the symptomatic side were correlated with early postoperative pain relief.
  
  
  RESULTS
  Although the degree and location of NVC were not statistically correlative independently, a combined interaction analysis of both statistically correlated with the symptomatic side and with early postoperative pain relief.
  
  
  CONCLUSIONS
  We conclude that in TGN patients treated with MVD, magnetic resonance imaging identified neurovascular compression at the root entry zone (correlates with the affected side and early postoperative pain relief.
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: axitamm@gmail.com.
authors.forename: Akshitkumar M
authors.initials: AM
authors.lastname: Mistry
authors.affiliation: College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Kurt J
authors.initials: KJ
authors.lastname: Niesner
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Wendell B
authors.initials: WB
authors.lastname: Lake
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Forbes
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Chevis N
authors.initials: CN
authors.lastname: Shannon
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Kasl
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Konrad
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Neimat
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000639:trends; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000639:trends; D008297:Male; D061145:Microvascular Decompression Surgery / Q000639:trends*; D055806:Microvessels / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D011843:Radiculopathy / Q000000981:diagnostic imaging* / Q000601:surgery*; D012189:Retrospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D014276:Trigeminal Nerve / Q000000981:diagnostic imaging / Q000601:surgery; D014277:Trigeminal Neuralgia / Q000000981:diagnostic imaging* / Q000601:surgery*
keywords: Microvascular decompression; Root entry zone; Trigeminal neuralgia