Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression

Albert Lee, Shirley McCartney, Cole Burbidge, Ahmed Raslan, Kim Burchiel

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Object. Vascular compression of the trigeminal nerve is the most common factor associated with the etiology of trigeminal neuralgia (TN). Microvascular decompression (MVD) has proven to be the most successful and durable surgical approach for this disorder. However, not all patients with TN manifest unequivocal neurovascular compression (NVC). Furthermore, over time patients with an initially successful MVD manifest a relentless rate of TN recurrence. Methods. The authors performed a retrospective review of cases of TN Type 1 (TN1) or Type 2 (TN2) involving patients 18 years or older who underwent evaluation (and surgery when indicated) at Oregon Health & Science University between July 2006 and February 2013. Surgical and imaging findings were correlated. Results. The review identified a total of 257 patients with TN (219 with TN1 and 38 with TN2) who underwent high-resolution MRI and MR angiography with 3D reconstruction of combined images using OsiriX. Imaging data revealed that the occurrence of TN1 and TN2 without NVC was 28.8% and 18.4%, respectively. A subgroup of 184 patients underwent surgical exploration. Imaging findings were highly correlated with surgical findings, with a sensitivity of 96% for TN1 and TN2 and a specificity of 90% for TN1 and 66% for TN2. Conclusions. Magnetic resonance imaging detects NVC with a high degree of sensitivity. However, despite a diagnosis of TN1 or TN2, a significant number of patients have no NVC. Trigeminal neuralgia clearly occurs and recurs in the absence of NVC.

Original languageEnglish (US)
Pages (from-to)1048-1054
Number of pages7
JournalJournal of Neurosurgery
Volume120
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Trigeminal Neuralgia
Microvascular Decompression Surgery
Trigeminal Nerve
Computer-Assisted Image Processing
Magnetic Resonance Angiography
Blood Vessels
Magnetic Resonance Imaging
Recurrence
Health

Keywords

  • Internal neurolysis
  • Lack of vascular compression
  • Microvascular decompression
  • Neurovascular compression
  • Peripheral nerve
  • Trigeminal neuralgia
  • Type 1 trigeminal neuralgia
  • Type 2 trigeminal neuralgia

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression. / Lee, Albert; McCartney, Shirley; Burbidge, Cole; Raslan, Ahmed; Burchiel, Kim.

In: Journal of Neurosurgery, Vol. 120, No. 5, 2014, p. 1048-1054.

Research output: Contribution to journalArticle

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