190 A Comparative Analysis of Operative and Radiographic Findings of Neurovascular Compression of the Trigeminal Nerve in Patients Without Trigeminal Neuralgia. (August 2016)

• Record Type: Journal Article
• Authors: Sekula, Raymond F.; Hughes, Marion; Mousavi, Hossein
• Is Part Of: Clinical neurosurgery. Volume 63(2016)Supplement 1
• Publication Date: 2016-08
• Subjects: Nervous system -- Surgery -- Congresses; Neurosurgery; Nervous system -- Surgery; Neurologie; Congresses; Conference papers and proceedings; 617.48
• DOI: 10.1227/01.neu.0000489759.35651.d4
• Languages: English
• ISSNs: 0069-4827

Abstract

Abstract : INTRODUCTION: Evidence of vascular compression of trigeminal nerve in patients without trigeminal neuralgia (TN) is limited to cadaveric and radiographic data. Intraoperative assessment of vascular compression and macroscopic effects on the trigeminal nerve has not been evaluated. The aim of this study was to assess whether individuals without TN exhibit vascular compression of the trigeminal nerve. Intraoperative and MRI findings were compared. METHODS: Prospectively, the trigeminal nerve was inspected from its root entry point to the porous trigeminus in 27 patients undergoing microvascular decompression for hemifacial spasm. Neurovascular compression by artery or vein (NVC) was stratified into 3 types: simple contact, compression (ie, indentation of the surface of the nerve), and deformity (ie, deviation or distortion of the nerve). All patients underwent a preoperative MRI including thin-section multiplanar steady-state-free precession imaging. RESULTS: Intraoperative and MR evidence of NVC was detected in 23 (85%) and 18 (67%) patients, respectively. There was agreement between the imaging and operative findings in 22 (81%) patients, κ = 0.52. Discrepancy of surgical and MR findings was observed in 5 patients, in which NVC was not detected on MRI. Neurovascular contact was identified in 83% (19/23) of patients intraoperatively and in 77% (14/18) of patients by imaging. Compression was identified in 17% (4/23) of patients intraoperatively and in 22% (4/18) of patients by imaging. No patients exhibited deformity of the nerve by imaging or intraoperatively. In patients where NVC was observed by both methods there was agreement regarding the severity of NVC in 83% (15/18) of patients, κ = 0.47. CONCLUSION: This prospective study suggests that intraoperative and imaging findings of NVC of the trigeminal nerve in patients without TN is limited to simple contact and compression. Importantly, no patients in this series were noted to exhibit deformity of the trigeminal nerve.