From the University of North Texas Health Science Center (T.T.), Fort Worth, Texas.
University of Texas Southwestern Medical Center (S.X.), Dallas, Texas.
AJNR Am J Neuroradiol. 2024 Apr 8;45(4):525-531. doi: 10.3174/ajnr.A8152.
Peripheral trigeminal neuropathies are assessed by MR neurography for presurgical mapping. In this clinical report, we aimed to understand the utility of MR neurography following nerve-repair procedures. We hypothesized that postoperative MR neurography assists in determining nerve integrity, and worsening MR neurography findings will corroborate poor patient outcomes. Ten patients with peripheral trigeminal neuropathy were retrospectively identified after nerve-repair procedures, with postsurgical MR neurography performed from July 2015 to September 2023. Postsurgical MR neurography findings were graded as per postintervention category and subcategories of the Neuropathy Score Reporting and Data System (NS-RADS). Descriptive statistics of demographics, inciting injury, injury severity, NS-RADS scoring, and clinical outcomes were obtained. There were 6 women and 4 men (age range, 25-73 years). Most injuries resulted from third molar removals (8/10), with an average time from the inciting event to nerve-repair surgery of 6.1 (SD, 4.6) months. In Neuropathy Score Reporting and Data System-Injury (NS-RADS I), NS-RADS I-4 injuries (neuroma in continuity) were found in 8/10 patients, and NS-RADS I-5 injuries were found in the remaining patients, all confirmed at surgery. Surgeries performed included microdissection with neurolysis, neuroma excision, and nerve allograft with Axoguard protection. Three patients with expected postsurgical MR neurography findings experienced either partial improvement or complete symptom resolution, while among 7 patient with persistent or recurrent neuropathy on postsurgical MR neurography, one demonstrated partial improvement of sensation, pain, and taste and one experienced only pain improvement; the remaining 5 patients demonstrated no improvement. Postsurgical MR neurography consistently coincided with clinical outcomes related to pain, sensation, and lip biting and speech challenges. Lip biting and speech challenges were most amenable to recovery, even with evidence of persistent nerve pathology on postsurgical MR neurography.
周围性三叉神经病变通过 MR 神经成像进行术前定位评估。在本临床报告中，我们旨在了解神经修复术后 MR 神经成像的作用。我们假设术后 MR 神经成像有助于确定神经完整性，并且 MR 神经成像结果恶化将证实患者预后不良。从 2015 年 7 月至 2023 年 9 月，我们回顾性地确定了 10 例周围性三叉神经病变患者在神经修复术后进行了术后 MR 神经成像。根据介入后类别和神经病变评分报告和数据系统 (NS-RADS) 的亚类对术后 MR 神经成像结果进行分级。获得了人口统计学、激发损伤、损伤严重程度、NS-RADS 评分和临床结果的描述性统计数据。患者包括 6 名女性和 4 名男性（年龄范围 25-73 岁）。大多数损伤是由于第三磨牙拔除引起的（8/10），从激发事件到神经修复手术的平均时间为 6.1（SD，4.6）个月。在神经病变评分报告和数据系统-损伤（NS-RADS I）中，8/10 例患者发现 NS-RADS I-4 损伤（连续性神经瘤），其余患者发现 NS-RADS I-5 损伤，所有患者均在手术中得到证实。手术包括显微解剖伴神经松解、神经瘤切除和 Axoguard 保护神经移植。3 例预期术后 MR 神经成像发现的患者经历了部分改善或完全症状缓解，而在 7 例术后 MR 神经成像中仍有神经病变的患者中，1 例感觉、疼痛和味觉部分改善，1 例仅疼痛改善；其余 5 例患者无改善。术后 MR 神经成像与与疼痛、感觉和咬唇以及言语障碍相关的临床结果一致。即使术后 MR 神经成像显示持续存在神经病变，咬唇和言语障碍也最容易恢复。
