The Role of Magnetic Resonance Imaging in Diagnosing Trigeminal Neuralgia. (16th November 2020)

• Record Type: Journal Article
• Authors: Darrow, David P; Quinn, Coridon; McKinney, Alexander; Grande, Andrew W; Haines, Stephen J
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_563
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Neurovascular compression has been the primary hypothesis for the underlying mechanism of trigeminal neuralgia for more than 40 years. While the efficacy of microvascular decompression remains the gold standard treatment, a substantial body of literature has emerged highlighting a high incidence of asymptomatic neurovascular compression captured on imaging, the existence of a considerable population of patients with clinical trigeminal neuralgia without neurovascular compression, and a long-term failure rate for more than one third of patients who have undergone MVD. Progressive improvements in magnetic resonance imaging continue provide better insight into neurovascular interaction, but the clinical use of imaging to support TN diagnosis or classify phenotype has not been investigated. METHODS: Accuracy across raters was analyzed and compared using intraclass coefficient, Kendall's W, and logistic regression to understand their quantitative contribution to classifying clinical diagnosis using only image features. RESULTS: 96 MRIs were evaluated, (49 from TGN patients, 47 from controls). Poor accuracy (no better than random) was found across reviewers using magnetic resonance imaging to diagnose trigeminal neuralgia. Moderate agreement was found between reviewers. Logistic Regression found no significant effects of age, gender, or side, but did find a small but significant contribution from the use of a typical grading scale as a linear ordinal variable on the prediction of trigeminal neuralgia diagnosis. CONCLUSION: Despite the existence of some data that MRI of neurovascular compression may provide some insight into clinical diagnosis, expert reviewers do no better than chance in predicting clinical diagnosis despite moderate agreement on reviews. Consistent reports of small effects from MRI feature extraction on grading the severity of compression suggests neurovascular compression as a mediating mechanism of trigeminal neuralgia with the underlying causal mechanism not captured by structural imaging.