Reliability of MRI for predicting characteristics of neurovascular conflicts in trigeminal neuralgia: implications for surgical decision making

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OBJECTIVE

The choice of microvascular decompression (MVD), among the several other surgical options, for treating refractory classical trigeminal neuralgia (TN) relies mostly on preoperative imaging, but the degree of reliability of MRI remains a matter of debate. The authors approached the question of predictability of neurovascular conflict (NVC) in a series of 100 protocolized MRI studies from patients with TN who underwent MVD, by reexamination of MR images, blinded to the clinical data and surgical findings, including the side of the neuralgia.

METHODS

Patients included in the study were those who underwent MVD after surgical indication had been determined based on a protocolized imagery workup (3D high-resolution T2-weighted cisternography centered on the trigeminal nerve, 3D time-of-flight angiography, and 3D gadolinium-enhanced T1-weighted imaging) performed at our institution. All MR images were blindly reexamined, and neurovascular relationships were described on both sides, noting the existence of compression, vessels involved, situation along the root, and degree of compression. The results of MRI evaluation were then compared with actual surgical findings. The extent of agreement and quality of the prediction were expressed with Cohen’s kappa coefficient (κ) and receiver operating characteristic (ROC) statistics.

RESULTS

A conflict had actually been found during surgery in 94 of 100 patients. The sensitivity of MRI to detect a conflict was 97% and the specificity was 50%. Vessel type was identified with high reliability (κ = 0.80), while the grade of the conflict and its situation along the root showed poor to average reliability (κ = 0.38 and κ = 0.40, respectively). The area under the ROC curve for predicting the presence of a conflict according to the grades of conflict seen on MRI was 0.93, which is considered very good. The positive predictive value was differentiated according to the grade of conflict, with a very high value for high grades of vascular conflict.

CONCLUSIONS

This study shows an overall good reliability of MRI to predict the existence of an NVC. The prediction value is excellent for high grades of compression. Some apparent low-grade compressions on MRI may be revealed as false positives in surgical exploration. This raises the question of what other imaging methods might be used to determine not only the existence of a conflict but also its degree of compression. The degree of compression is of paramount importance to predict the probability of long-term pain relief, and therefore in the decision to propose MVD as the first choice of surgical treatment.

ABBREVIATIONS AICA = anterior inferior cerebellar artery; BA = basilar artery; MVD = microvascular decompression; NVC = neurovascular conflict; NVR = neurovascular relationship; ROC = receiver operating characteristic; SCA = superior cerebellar artery; SPVS = superior petrosal venous system; TN = trigeminal neuralgia; TOF = time of flight; TREZ = trigeminal root entry zone; VA = vertebral artery.

Article Information

Correspondence Andrei Brînzeu: Hôpital Neurologique, Lyon, France. andrei.brinzeu@chu-lyon.fr.

INCLUDE WHEN CITING Published online April 6, 2018; DOI: 10.3171/2017.8.JNS171222.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    ROC curves for different definitions of NVC. n.s. = not significant.

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    Errors in predicting the side of neuralgia. Figure is available in color online only.

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    Comparison of the grading of conflicts on the symptomatic and asymptomatic sides in patients with bilateral conflicts.

References

  • 1

    Adams CB: Microvascular compression: an alternative view and hypothesis. J Neurosurg 70:1121989

  • 2

    Alper JShrivastava RKBalchandani P: Is there a magnetic resonance imaging-discernible cause for trigeminal neuralgia? A structured review. World Neurosurg 98:89972017

  • 3

    Anderson VCBerryhill PCSandquist MACiaverella DPNesbit GMBurchiel KJ: High-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled gradient-recalled imaging in the evaluation of neurovascular compression in patients with trigeminal neuralgia: a double-blind pilot study. Neurosurgery 58:6666732006

  • 4

    Antonini GDi Pasquale ACruccu GTruini AMorino SSaltelli G: Magnetic resonance imaging contribution for diagnosing symptomatic neurovascular contact in classical trigeminal neuralgia: a blinded case-control study and meta-analysis. Pain 155:146414712014

  • 5

    Boecher-Schwarz HGBruehl KKessel GGuenthner MPerneczky AStoeter P: Sensitivity and specificity of MRA in the diagnosis of neurovascular compression in patients with trigeminal neuralgia. A correlation of MRA and surgical findings. Neuroradiology 40:88951998

  • 6

    Borgaro SRGierok SCaples HKwasnica C: Fatigue after brain injury: initial reliability study of the BNI Fatigue Scale. Brain Inj 18:6856902004

  • 7

    Burchiel KJ: Trigeminal neuralgia: new evidence for origins and surgical treatment. Neurosurgery 63 (Suppl 1):52552016

  • 8

    Chen MJZhang WJGuo ZLYang CZhang WHDong MJ: Preoperative evaluation of the neurovascular compression using magnetic resonance tomographic angiography: our radiologic indications for microvascular decompression to treat trigeminal neuralgia. J Craniofac Surg 25:e384e3882014

  • 9

    Chun-Cheng QQing-Shi ZJi-Qing ZZhi-Gang W: A single-blinded pilot study assessing neurovascular contact by using high-resolution MR imaging in patients with trigeminal neuralgia. Eur J Radiol 69:4594632009

  • 10

    Cohen J: A coefficient of agreement for nominal scales. Educ Psychol Meas 20:37461960

  • 11

    Cruccu GFinnerup NBJensen TSScholz JSindou MSvensson P: Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology 87:2202282016

  • 12

    De Ridder DMøller AVerlooy JCornelissen MDe Ridder L: Is the root entry/exit zone important in microvascular compression syndromes? Neurosurgery 51:4274342002

  • 13

    DeSouza DDHodaie MDavis KD: Abnormal trigeminal nerve microstructure and brain white matter in idiopathic trigeminal neuralgia. Pain 155:37442014

  • 14

    DeSouza DDHodaie MDavis KD: Structural magnetic resonance imaging can identify trigeminal system abnormalities in classical trigeminal neuralgia. Front Neuroanat 10:952016

  • 15

    Duan YSweet JMunyon CMiller J: Degree of distal trigeminal nerve atrophy predicts outcome after microvascular decompression for Type 1a trigeminal neuralgia. J Neurosurg 123:151215182015

  • 16

    Dumot CBrinzeu ABerthiller JSindou M: Trigeminal neuralgia due to venous neurovascular conflicts: outcome after microvascular decompression in a series of 55 consecutive patients. Acta Neurochir (Wien) 159:2372492017

  • 17

    Erbay SHBhadelia RAO’Callaghan MGupta PRiesenburger RKrackov W: Nerve atrophy in severe trigeminal neuralgia: noninvasive confirmation at MR imaging—initial experience. Radiology 238:6896922006

  • 18

    Hallgren KA: Computing inter-rater reliability for observational data: an overview and tutorial. Tutor Quant Methods Psychol 8:23342012

  • 19

    Hanley JAMcNeil BJ: The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29361982

  • 20

    Lang ENaraghi RTanrikulu LHastreiter PFahlbusch RNeundörfer B: Neurovascular relationship at the trigeminal root entry zone in persistent idiopathic facial pain: findings from MRI 3D visualisation. J Neurol Neurosurg Psychiatry 76:150615092005

  • 21

    Lasko TABhagwat JGZou KHOhno-Machado L: The use of receiver operating characteristic curves in biomedical informatics. J Biomed Inform 38:4044152005

  • 22

    Leal PRLBarbier 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

  • 23

    Leal PRLHermier MFroment JCSouza MACristino-Filho GSindou M: Preoperative demonstration of the neurovascular compression characteristics with special emphasis on the degree of compression, using high-resolution magnetic resonance imaging: a prospective study, with comparison to surgical findings, in 100 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Acta Neurochir (Wien) 152:8178252010

  • 24

    Leal PRLRoch JAHermier MSouza MANCristino-Filho GSindou M: Structural abnormalities of the trigeminal root revealed by diffusion tensor imaging in patients with trigeminal neuralgia caused by neurovascular compression: a prospective, double-blind, controlled study. Pain 152:235723642011

  • 25

    Maarbjerg SSørensen MTGozalov ABendtsen LOlesen J: Field-testing of the ICHD-3 beta diagnostic criteria for classical trigeminal neuralgia. Cephalalgia 35:2913002015

  • 26

    Maarbjerg SWolfram FGozalov AOlesen JBendtsen L: Significance of neurovascular contact in classical trigeminal neuralgia. Brain 138:3113192015

  • 27

    Masuda YYamamoto TAkutsu HShiigai MMasumoto TIshikawa E: Usefulness of subtraction of 3D T2WI-DRIVE from contrast-enhanced 3D T1WI: preoperative evaluations of the neurovascular anatomy of patients with neurovascular compression syndrome. AJNR Am J Neuroradiol 36:3173222015

  • 28

    McCartney SWeltin MBurchiel KJ: Use of an artificial neural network for diagnosis of facial pain syndromes: an update. Stereotact Funct Neurosurg 92:44522014

  • 29

    Meaney JFEldridge PRDunn LTNixon TEWhitehouse GHMiles JB: Demonstration of neurovascular compression in trigeminal neuralgia with magnetic resonance imaging. Comparison with surgical findings in 52 consecutive operative cases. J Neurosurg 83:7998051995

  • 30

    Miller JAcar FHamilton BBurchiel K: Preoperative visualization of neurovascular anatomy in trigeminal neuralgia. J Neurosurg 108:4774822008

  • 31

    Miller JPAcar FHamilton BEBurchiel KJ: Radiographic evaluation of trigeminal neurovascular compression in patients with and without trigeminal neuralgia. J Neurosurg 110:6276322009

  • 32

    Mistry AMNiesner KJLake WBForbes JAShannon CNKasl RA: Neurovascular compression at the root entry zone correlates with trigeminal neuralgia and early microvascular decompression outcome. World Neurosurg 95:2082132016

  • 33

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

  • 34

    Patel NKAquilina KClarke YRenowden SACoakham HB: How accurate is magnetic resonance angiography in predicting neurovascular compression in patients with trigeminal neuralgia? A prospective, single-blinded comparative study. Br J Neurosurg 17:60642003

  • 35

    Peker SDinçer ANecmettin Pamir M: Vascular compression of the trigeminal nerve is a frequent finding in asymptomatic individuals: 3-T MR imaging of 200 trigeminal nerves using 3D CISS sequences. Acta Neurochir (Wien) 151:108110882009

  • 36

    Satoh TOmi MNabeshima MOnoda KDate I: Severity analysis of neurovascular contact in patients with trigeminal neuralgia: assessment with the inner view of the 3D MR cisternogram and angiogram fusion imaging. AJNR Am J Neuroradiol 30:6036072009

  • 37

    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

  • 38

    Sindou MLeston JDecullier EChapuis F: Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg 107:114411532007

  • 39

    Wäljas MIverson GLHartikainen KMLiimatainen SDastidar PSoimakallio S: Reliability, validity and clinical usefulness of the BNI fatigue scale in mild traumatic brain injury. Brain Inj 26:9729782012

  • 40

    Zou KHO’Malley AJMauri L: Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models. Circulation 115:6546572007

  • 41

    Zweig MHCampbell G: Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 39:5615771993

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