Departments of Radiology, Otolaryngology, and Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA.
Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York , New York , USA.
Neurosurgery. 2024 Mar 1;94(3):524-528. doi: 10.1227/neu.0000000000002671. Epub 2023 Sep 14.
Classical trigeminal neuralgia (cTN) is a painful disease. Microvascular decompression (MVD) provides immediate and durable relief in many patients. A variety of positive and negative prognostic biomarkers for MVD have been identified. The sagittal angle of the trigeminal nerve at the porus trigeminus (SATNaPT) is an MRI biomarker that can identify a subset of patients with cTN whose trigeminal nerve anatomy is different from normal controls. The purpose of this case-control study was to determine whether an abnormally hyperacute SATNaPT is a negative prognostic biomarker in patients with cTN undergoing MVD.
Preoperative MRIs from 300 patients with cTN who underwent MVD were analyzed to identify patients with a hyperacute SATNaPT (defined as less than 3 SDs below the mean). The rate of surgical success (pain-free after at least 12 months) was compared between patients with a hyperacute SATNaPT and all other patients.
Patients without a hyperacute SATNaPT had an 82% likelihood of surgical success, whereas patients with a hyperacute SATNaPT had a 58% likelihood of surgical success ( P < .05). Patients with a hyperacute SATNaPT who also had no evidence of vascular compression on preoperative MRI had an even lower likelihood of success (29%, P < .05).
In patients with cTN being considered for MVD, a hyperacute SATNaPT is a negative prognostic biomarker that predicts a higher likelihood of surgical failure. Patients with a hyperacute SATNaPT, particularly those without MRI evidence of vascular compression, may benefit from other surgical treatments or a modification of MVD to adequately address the underlying cause of cTN.
经典三叉神经痛（cTN）是一种疼痛性疾病。微血管减压术（MVD）可使许多患者立即且持久地缓解疼痛。已经确定了多种用于 MVD 的阳性和阴性预后生物标志物。三叉神经根孔处三叉神经矢状角（SATNaPT）是一种 MRI 生物标志物，可识别出一小部分 cTN 患者的三叉神经解剖结构与正常对照组不同。本病例对照研究的目的是确定在接受 MVD 的 cTN 患者中，异常超急性 SATNaPT 是否是一个负面的预后生物标志物。
分析了 300 例接受 MVD 的 cTN 患者的术前 MRI，以识别 SATNaPT 超急性的患者（定义为低于平均值 3 个标准差以下）。比较 SATNaPT 超急性的患者与所有其他患者的手术成功率（至少 12 个月无疼痛）。
无 SATNaPT 超急性的患者手术成功率为 82%，而 SATNaPT 超急性的患者手术成功率为 58%（P<.05）。在术前 MRI 上没有发现血管压迫的 SATNaPT 超急性患者，其成功率甚至更低（29%，P<.05）。
在考虑接受 MVD 的 cTN 患者中，SATNaPT 超急性是一个负面的预后生物标志物，预测手术失败的可能性更高。具有 SATNaPT 超急性的患者，特别是那些没有 MRI 血管压迫证据的患者，可能受益于其他手术治疗或 MVD 的修改，以充分解决 cTN 的根本原因。
