The Use of MRI in Preoperative Decision-Making for Trigeminal Neuralgia: A Single-Center Study
| Autor: | Barton L. Guthrie, Nicholas J Erickson, James Mooney, Bonita S. Agee, Bruce C. Pittman |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Clinical Decision-Making Microvascular decompression Single Center Sensitivity and Specificity Neurosurgical Procedures Rhizotomy 03 medical and health sciences Postoperative Complications 0302 clinical medicine Refractory Trigeminal neuralgia Preoperative Care Humans Medicine MVDS Aged Pain Measurement medicine.diagnostic_test business.industry Nerve Compression Syndromes Magnetic resonance imaging Middle Aged Trigeminal Neuralgia medicine.disease Magnetic Resonance Imaging Confidence interval Microvascular Decompression Surgery Treatment Outcome 030220 oncology & carcinogenesis Female Surgery Neurology (clinical) Radiology business 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 146:e651-e657 |
| ISSN: | 1878-8750 |
| Popis: | Objective Few studies have examined associations between vascular compression and postoperative pain relief in patients undergoing microvascular decompression (MVD) for treatment of medically refractory type 1 trigeminal neuralgia (TN). The authors sought to examine for associations between vascular compression and postoperative pain relief to determine the utility of preoperative magnetic resonance imaging (MRI) in surgical decision-making for TN. Methods The charts of 59 patients who underwent 60 MVDs for TN between 2007 and 2017 at a single academic institution were reviewed. Patient demographics, the presence of compressing vessel on preoperative MRI and intraoperatively, complications, follow-up time, performance of a partial sensory rhizotomy, and pain resolution at most recent follow-up were recorded. Sensitivity and specificity of MRI for detecting vascular compression were calculated and associations between preoperative and intraoperative evidence of vascular compression with postoperative pain relief were examined. Results Sensitivity and specificity of preoperative MRI determined through blinded reads by the senior author were 65.3% (95% confidence interval, 13.5–32.0) and 90.9% (95% confidence interval, 86.1–100.0), respectively. Overall, 76.3% of patients were pain free at most recent follow-up. Preoperative MRI and intraoperative evidence of vascular compression were not associated with postoperative pain relief at most recent follow-up (P = 0.47 and 0.43, respectively). Conclusions The findings of lower sensitivity and poor interrater reliability of MRI, as well as a lack of association between compressive vessel and postoperative pain relief reported in this study, suggest the decision to pursue MVD for TN should be based more heavily on classic symptomatic presentation over preoperative evidence of vascular compression. |
| Databáze: | OpenAIRE |
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