Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China.
Department of Anaesthesiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China.
BMC Neurol. 2024 Nov 29;24(1):466. doi: 10.1186/s12883-024-03977-6.
Patients with trigeminal neuralgia frequently undergo magnetic resonance imaging (MRI) prior to surgery. In patients without the signs and symptoms of face discomfort, MRI has shown the presence of neurovascular contact (NVC) in humans. Therefore, its capacity to accurately exclude NVC of the trigeminal nerve is not properly understood. A meta-analysis of the literature satisfied the criteria to further explore the value of MRI for the diagnosis of classical trigeminal neuralgia (CTN).
The association between the symptomatic and asymptomatic trigeminal nerves, NVC, root entry zone (REZ), non-REZ, and anatomical variation was measured by a comprehensive review and meta-analysis of 13 observational studies using MRI for CTN neurovascular compression diagnosis.
This study aimed to evaluate the effectiveness of MRI in detecting the neurovascular compression that causes symptoms in individuals with classic trigeminal neuralgia.
This study was conducted at the Department of Neurosurgery, Yantai Yuhuangding Hospital, Qingdao University.
Digital searches of PubMed, Embase, and the Cochrane Library were performed to identify studies published until December 31, 2023. The following were evaluated: (1) MRI evidence of NVC in symptomatic and asymptomatic trigeminal nerves; (2) MRI indication of NVC at the REZ in symptomatic and asymptomatic trigeminal nerves; (3) MRI substantiation of non-REZ neurovascular contact in patients with CTN; and (4) asymptomatic and symptomatic anatomical changes at the NVC site of the trigeminal nerves. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the fixed effects models.
We identified 13 observational studies (1 prospective and 12 retrospective studies) with data collected from 1770 nerves (728 symptomatic and 1042 asymptomatic) were meta-analyzed. First, MRI of 649/728 (88.2%) symptomatic versus 378/1042 (36.3%) asymptomatic trigeminal nerves revealed marked differences in NVC in the REZ (OR = 16.3; CI 95%=12.2-21.8; p < 0.00001). Second, pooled data showed that REZ NVC was detected in 206/262 (78.6%) symptomatic and in 129/340 (37.9%) asymptomatic nerves (OR = 5.0; CI 95% = 3.4-7.3; p < 0.00001); Third, no significant differences were detected between 44/267 (16.5%) symptomatic and 23/189 (12.1%) asymptomatic nerves on MRI examination of NVC in the NON-REZ (OR = 0.9; CI 95% 0.5-1.6) (p = 0.77); Finally, MRI revealed marked differences in 302/567 (53.2%) symptomatic and 73/919 (7.9%) asymptomatic anatomic changes (atrophy, dislocation, distorsion, flattening or indentation) at the NVC site of the trigeminal segments (OR = 11.9; CI 95% = 8.8-16.2; p < 0.00001).
Despite the systematic evaluation of 13 observational studies, large-scale randomized controlled trials should be conducted, focusing on the specificity of MRI for the diagnosis of trigeminal neuralgia and evaluating the specificity of the imaging findings and the impact of the patient's postoperative treatment.
A previous meta-analysis showed that patients with CTN were more likely to have NVC-specific anatomical changes. MRI of patients with CTN can detect anatomical changes in the REZ NVC with higher sensitivity.
三叉神经痛患者常在手术前进行磁共振成像（MRI）检查。在没有面部不适症状和体征的患者中，MRI 显示存在神经血管接触（NVC）。因此，MRI 准确排除三叉神经 NVC 的能力尚不清楚。一项对文献的荟萃分析符合进一步探讨 MRI 对经典三叉神经痛（CTN）诊断价值的标准。
通过对使用 MRI 诊断 CTN 神经血管压迫的 13 项观察性研究进行综合回顾和荟萃分析，测量了症状性和无症状性三叉神经、NVC、神经根入口区（REZ）、非-REZ 和解剖变异之间的关联。
本研究旨在评估 MRI 在检测引起经典三叉神经痛症状的神经血管压迫方面的有效性。
本研究在青岛大学烟台毓璜顶医院神经外科进行。
对 PubMed、Embase 和 Cochrane 图书馆进行数字检索，以确定截至 2023 年 12 月 31 日发表的研究。评估内容包括：（1）MRI 对症状性和无症状性三叉神经 NVC 的证据；（2）MRI 对症状性和无症状性三叉神经 REZ 处 NVC 的指示；（3）MRI 对 CTN 患者非-REZ 神经血管接触的证实；（4）三叉神经 NVC 部位无症状和有症状的解剖变化。使用固定效应模型计算比值比（OR）及其 95%置信区间（CI）。
我们确定了 13 项观察性研究（1 项前瞻性和 12 项回顾性研究），共纳入 1770 条神经（728 条症状性和 1042 条无症状性）进行荟萃分析。首先，649/728（88.2%）症状性 versus 378/1042（36.3%）无症状三叉神经的 MRI 显示 REZ 处 NVC 存在显著差异（OR=16.3；95%CI 12.2-21.8；p<0.00001）。其次，汇总数据显示，262/267（78.6%）症状性和 340/340（37.9%）无症状神经的 MRI 显示 REZ NVC（OR=5.0；95%CI 3.4-7.3；p<0.00001）。第三，在非-REZ 处 NVC 的 MRI 检查中，44/267（16.5%）症状性和 23/189（12.1%）无症状神经之间未发现显著差异（OR=0.9；95%CI 0.5-1.6）（p=0.77）。最后，MRI 显示 302/567（53.2%）症状性和 73/919（7.9%）无症状三叉神经节 NVC 部位存在明显的解剖变化（萎缩、脱位、扭曲、扁平或凹陷）（OR=11.9；95%CI 8.8-16.2；p<0.00001）。
尽管对 13 项观察性研究进行了系统评估，但仍需进行大规模随机对照试验，重点关注 MRI 对三叉神经痛诊断的特异性，并评估影像学发现的特异性和患者术后治疗的影响。
先前的荟萃分析表明，CTN 患者更有可能出现 NVC 特异性解剖变化。CTN 患者的 MRI 可以更敏感地检测到 REZ NVC 的解剖变化。
