Ansari Shehbaz, Mu Brian H, Basappa Eric R, Akyuz Melih, Jhaveri Miral D, Gaddikeri Santhosh
Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653W Congress Parkway, Chicago, IL 60612, USA.
Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653W Congress Parkway, Chicago, IL 60612, USA.
Curr Probl Diagn Radiol. 2025 Sep-Oct;54(5):585-589. doi: 10.1067/j.cpradiol.2025.05.003. Epub 2025 May 11.
The sagittal angle of the trigeminal nerve at the porus trigeminus (SATNaPT) has been described as abnormally hyperacute in a subset of patients with trigeminal neuralgia and proposed as a potential marker for the likelihood of poor microvascular decompression (MVD) outcomes. The purpose of this study is to replicate these results and evaluate this hypothesized association by comparing the SATNaPT between MVD responders and non-responders.
At a single institution, 80 patients with a clinical diagnosis of trigeminal neuralgia, surgical intervention with MVD, and available adequate high-resolution T2 imaging were identified. SATNaPT was measured between the cisternal segment of the trigeminal nerve and its uppermost branch in the Meckel cave by a blinded observer. These data were evaluated for normality of distribution and compared between responders and non-responders to MVD as well as between affected and unaffected sides. Non-response to MVD was defined as persistent pain requiring continuous medication postoperatively or progression to secondary interventions.
There were 43 (52.5 %) responders and 39 (47.5 %) non-responders to MVD. Two patients had bilateral disease for 82 affected sides and 78 unaffected sides. The mean SATNaPT among responders was 150.5° (SD: ±10.6°), which was not significantly different (p = 0.21) from the 153.1° (SD: ±8.0°) mean angle in non-responders. Mean SATNaPT was not significantly different (p = 0.10) between the affected (mean: 151.7°, SD: ±9.5°) and the unaffected (mean: 153.1°, SD: ±10.0°) sides.
Our study did not replicate the bimodal distribution of the SATNaPT in cTN patients. No statistically significant difference was noted in the SATNaPT between responders and non-responders to MVD or between symptomatic and asymptomatic sides.
三叉神经在三叉神经孔处的矢状角（SATNaPT）在部分三叉神经痛患者中被描述为异常锐，并且被认为是微血管减压术（MVD）预后不良可能性的潜在标志物。本研究的目的是重复这些结果，并通过比较MVD反应者和无反应者之间的SATNaPT来评估这一假设的关联。
在单一机构中，确定了80例临床诊断为三叉神经痛、接受MVD手术干预且有可用的足够高分辨率T2成像的患者。由一名不知情的观察者测量三叉神经脑池段与其在Meckel腔内最上分支之间的SATNaPT。评估这些数据的分布正态性，并在MVD反应者和无反应者之间以及患侧和未患侧之间进行比较。对MVD无反应定义为术后持续疼痛需要持续用药或进展为二次干预。
有43例（52.5%）MVD反应者和39例（47.5%）无反应者。2例患者为双侧疾病，共82个患侧和78个未患侧。反应者的平均SATNaPT为150.5°（标准差：±10.6°），与无反应者的平均角度153.1°（标准差：±8.0°）无显著差异（p = 0.21）。患侧（平均：151.7°，标准差：±9.5°）和未患侧（平均：153.1°，标准差：±10.0°）之间的平均SATNaPT无显著差异（p = 0.10）。
我们的研究未重复慢性三叉神经痛（cTN）患者中SATNaPT的双峰分布。在MVD反应者和无反应者之间或有症状侧和无症状侧之间，SATNaPT未观察到统计学上的显著差异。
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