Introduction: The aim of this study was to identify preoperative imaging predictors of surgical success in patients with classical trigeminal neuralgia undergoing microvascular decompression.
Methods: All patients included met criteria for classical trigeminal neuralgia and underwent a preoperative MRI prior to microvascular decompression. MRI scans were blindly graded regarding the presence and severity (i.e., mild or severe) of neurovascular compression. All patients were contacted by phone and questioned regarding their present pain status.
Results: A total of 79 patients were included in this study. Sixty-two patients (78.5%) were pain-free without medication following microvascular decompression. The following findings were more commonly observed with the symptomatic nerve when compared to the contralateral asymptomatic nerve: neurovascular compression (any form), arterial compression alone, neurovascular compression along the proximal trigeminal nerve, and severe neurovascular compression (p values <0.05). The only imaging variable that was a statistically significant predictor of being pain-free without medication following microvascular was severe neurovascular compression. Patients with severe neurovascular compression were 6.36 times more likely to be pain free following MVD compared to those without severe neurovascular compression (p=0.007).
Conclusions: In patients with classical trigeminal neuralgia undergoing microvascular decompression, severe neurovascular compression on MRI is a strong predictor of an excellent surgical outcome.
Patient Care: Identification of imaging findings that predict pain-free status after microvascular decompression will help improve selection of candidates for surgery and optimize chances of excellent outcomes.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify imaging findings predictive of pain-free status after microvascular decompression.
2) Compare imaging findings in symptomatic and asymptomatic nerves in patients with trigeminal neuralgia.
3) Discuss the use of imaging to select ideal candidates for microvascular decompression.