Analysis of the etiology of trigeminal neuralgia with no responsible vascular compression on MRI examination
Objective To analyze the causes of trigeminal neuralgia without vascular compression by MRI.Methods The clinical data of 86 patients with trigeminal neuralgia diagnosed in the second neurosurgery ward of Zhoukou Central Hospital from January 2018 to September 2023,who underwent microvascular decompression without preoperative MRI findings of vascular compression,were retrospectively analyzed,and 74 of them met the inclusion criteria.Endoscopic images obtained during microvascular decompression and postoperative follow-up were used as reference standards,and the images were read separately by radiologists with more than five years of experience,and the images of responsible vessels not found in MRI preoperative examination were analyzed.Postoperative outcomes were assessed using the Barrow neurological institute pain intensity score,and the differences were compared using a repeated measures analysis of variance.Results Among the 74 patients with trigeminal neuralgia,30 cases(40.5%)had intraoperative venous compression,15 cases(20.3%)had venous compression with arachnoid adhesion,12 cases(16.2%)had arterial branch compression,11 cases(14.9%)had arachnoid adhesion,3 cases(4.1%)had tumor compression,and 3 cases(4.1%)had no intraoperative vascular compression or arachnoid adhesion.Compared with before operation,the pain of patients was significantly relieved at all time points after operation,and the difference was statistically significant(P<0.05).Conclusion MRI is commonly used in the preoperative diagnosis of trigeminal neuralgia,which can clearly show the neurovascular interaction.Different surgical strategies should be adopted for different causes of trigeminal neuralgia.A specific test sequence is required for trigeminal neuralgia patients without vascular compression and whose secondary cause is unknown,and imaging doctors should check the medical history carefully and make comprehensive analysis to improve the diagnostic accuracy.
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