Sex-dependent posterior fossa anatomical differences in trigeminal neuralgia patients with and without neurovascular compression: a volumetric MRI age- and sex-matched case-control study

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OBJECTIVE

The pathophysiology of trigeminal neuralgia (TN) in patients without neurovascular compression (NVC) is not completely understood. The objective of this retrospective study was to evaluate the hypothesis that TN patients without NVC differ from TN patient with NVC with respect to brain anatomy and demographic characteristics.

METHODS

Six anatomical brain measurements from high-resolution brain MR images were tabulated; anterior-posterior (AP) prepontine cistern length, cerebellopontine angle (CPA) cistern volume, nerve-to-nerve distance, symptomatic nerve length, pons volume, and posterior fossa volume were assessed on OsiriX. Brain MRI anatomical measurements from 232 patients with either TN type 1 or TN type 2 (TN group) were compared with measurements obtained in 100 age- and sex-matched healthy controls (control group). Two-way ANOVA tests were conducted on the 6 measurements relative to group and NVC status. Bonferroni adjustments were used to correct for multiple comparisons. A nonhierarchical k-means cluster analysis was performed on the TN group using age and posterior fossa volume as independent variables.

RESULTS

Within the TN group, females were found to be younger than males and less likely to have NVC. The odds ratio (OR) of females not having NVC compared to males was 2.7 (95% CI 1.3–5.5, p = 0.017). Patients younger than 30 years were much less likely to have NVC compared to older patients (OR 4.9, 95% CI 1.3–18.4, p = 0.017). The mean AP prepontine cistern length and symptomatic nerve length were smaller in the TN group than in the control group (5.3 vs 6.5 mm and 8.7 vs 9.7 mm, respectively; p < 0.001). The posterior fossa volume was significantly smaller in TN patients without NVC compared to those with NVC. A TN group cluster analysis suggested a sex-dependent difference that was not observed in those without NVC. Factorial ANOVA and post hoc testing found that findings in males without NVC were significantly different from those in controls or male TN patients with NVC and similar to those in females (female controls as well as female TN patients with or without NVC).

CONCLUSIONS

Posterior fossa volume in males was larger than posterior fossa volume in females. This finding, along with the higher incidence of TN in females, suggests that smaller posterior fossa volume might be an independent factor in the pathophysiology of TN, which warrants further study.

ABBREVIATIONS AP = anterior-posterior; BFFE = balanced fast field echo; CPA = cerebellopontine angle; IN = internal neurolysis; MVD = microvascular decompression; NVC = neurovascular compression; TN = trigeminal neuralgia; TN1 = TN type 1; TN2 = TN type 2.

Article Information

Correspondence Ahmed M. Raslan: Oregon Health & Science University, Portland, OR. raslana@ohsu.edu.

INCLUDE WHEN CITING Published online February 1, 2019; DOI: 10.3171/2018.9.JNS181768.

F.A.H. and K.H. contributed equally to this work and share first authorship.

Disclosures Dr. Raslan reports a consultant relationship with Abbott.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Representative axial T2-weighted MR images showing the measurements used in this study. A: Pontine volume (cm3). B: Symptomatic nerve length (mm). C: CPA cistern volume (cm3). D: Nerve-to-nerve distance (cm). E: Posterior fossa volume (cm3). F: AP prepontine cistern length (mm). Figure is available in color online only.

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    Age, NVC, and sex relationships among patients with TN. The values on the y-axis are percentages.

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    Relationship between age group and presence of NVC (in percentages) among all patients with TN. The y-axis indicates percentage within age group.

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    Scatter plot depicting k-means cluster membership among TN patients. The x-axis indicates age (years), and the y-axis indicates posterior fossa volume (cm3). Figure is available in color online only.

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    Sex and mean posterior fossa volume in patients with TN, with and without NVC. * Statistically significant difference.

References

  • 1

    Caranci GMercurio AAltieri MDi Piero V: Trigeminal neuralgia as the sole manifestation of an Arnold-Chiari type I malformation: case report. Headache 48:6256272008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Cheng JMeng JLiu WZhang HHui XLei D: Primary trigeminal neuralgia is associated with posterior fossa crowdedness: a prospective case-control study. J Clin Neurosci 47:89922018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Horínek DBrezová VNimsky CBelsan TMartinkovic LMasopust V: The MRI volumetry of the posterior fossa and its substructures in trigeminal neuralgia: a validated study. Acta Neurochir (Wien) 151:6696752009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Jannetta PJ: Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 26 (1 Suppl):1591621967

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Kakizawa YSeguchi TKodama KOgiwara TSasaki TGoto T: Anatomical study of the trigeminal and facial cranial nerves with the aid of 3.0-tesla magnetic resonance imaging. J Neurosurg 108:4834902008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Kawano YMaehara TOhno K: Validation and evaluation of the volumetric measurement of cerebellopontine angle cistern as a prognostic factor of microvascular decompression for primary trigeminal neuralgia. Acta Neurochir (Wien) 156:117311792014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Ko ALLee ARaslan AMOzpinar AMcCartney SBurchiel KJ: Trigeminal neuralgia without neurovascular compression presents earlier than trigeminal neuralgia with neurovascular compression. J Neurosurg 123:151915272015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Kress BRasche DFiebach JTronnier VSartor KStippich C: [MR volumetry of the trigeminal nerve in patients with unilateral facial pain.] Rofo 176:7197232004 (Ger)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Leal PRBarbier CHermier MSouza MACristino-Filho GSindou M: 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. J Neurosurg 120:148414952014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Lee AMcCartney SBurbidge CRaslan AMBurchiel KJ: Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression. J Neurosurg 120:104810542014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Papanastassiou AMSchwartz RBFriedlander RM: Chiari I malformation as a cause of trigeminal neuralgia: case report. Neurosurgery 63:E614E6152008

    • Search Google Scholar
    • Export Citation
  • 12

    Parise MAcioly MARibeiro CTVincent MGasparetto EL: The role of the cerebellopontine angle cistern area and trigeminal nerve length in the pathogenesis of trigeminal neuralgia: a prospective case-control study. Acta Neurochir (Wien) 155:8638682013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Park SHHwang SKLee SHPark JHwang JHHamm IS: Nerve atrophy and a small cerebellopontine angle cistern in patients with trigeminal neuralgia. J Neurosurg 110:6336372009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Park YSHa SM: Does a small posterior fossa increase nerve vascular conflict in trigeminal neuralgia? Acta Radiol 56:151415182015

  • 15

    Rasche DKress BStippich CNennig ESartor KTronnier VM: Volumetric measurement of the pontomesencephalic cistern in patients with trigeminal neuralgia and healthy controls. Neurosurgery 59:6146202006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Sindou MHoweidy TAcevedo G: Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia (with correlations between topography of pain and site of the neurovascular conflict). Prospective study in a series of 579 patients. Acta Neurochir (Wien) 144:1132002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Than KDSharifpour MWang ACThompson BGPandey AS: Chiari I malformation manifesting as bilateral trigeminal neuralgia: case report and review of the literature. J Neurol Neurosurg Psychiatry 82:105810592011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Vince GHBendszus MWestermaier TSolymosi LErnestus RIMatthies C: Bilateral trigeminal neuralgia associated with Chiari’s type I malformation. Br J Neurosurg 24:4744762010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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