Cerebrovascular neurosurgeon Risheng Xu recaps his trigeminal neuralgia treatment presentation at the 2022 Congress of Neurological Surgeons annual meeting. His research sought to understand the differences between arterial and venous compression in pain presentation and in relief following microvascular decompression. His findings suggest that if preoperative MRIs can accurately identify a patient’s source of compression as either arterial or venous, then improved preoperative counseling can be provided.
Hello. My name is dr rushing shoe and I am a cerebrovascular neurosurgeon at johns Hopkins, One of the pathologies that I treat is trigeminal neuralgia and today I want to share with you some of the laboratory findings that we presented at c. s. 2022. Trigeminal neuralgia is a disorder that significantly impairs patient quality of life and it causes intense pain episodes in the trigeminal distribution in the face. As a result, patients can have extreme difficulty engaging in routine daily activities such as eating, brushing their teeth and encountering temperature changes. Although the exact path of physiology of this disease remains unknown, it's accepted that the majority of cases arises from conflict between the trigeminal nerve and surrounding cerebral vascular room. Most often the trigeminal nerve is compressed by the superior sara Bella artery. However, an important subset of patients demonstrates venus compression with no arterial involvement. The differences in pain presentation and relief following microvascular decompression between arterial and venus compression are not well understood and that is why we sought to address these gaps by analyzing a large cohort of patients undergoing microvascular decompression. With either soul arterial or soul venus compression. We found that out of 1020 patients, a total of 648 had either sole arterial or venous compression of the trigeminal nerve. 514 patients demonstrated soul arterial compression as opposed to 134 patients with only Venus compression. What we found was that patients in the venus compression group were significantly younger than those in the arterial group and compared to the arterial compression group, patients with soul venus compression had significantly worse preoperative, three month follow up, six month follow up, one year follow up and last follow up pain and so patients with venus compression were more likely to have recurrent pain and demonstrated a significantly lower time to recurrence than the arterial compression group. In conclusion, patients with soul venus compression of the trigeminal nerve are more likely to have worse pain outcomes following microvascular decompression compared to those with only arterial compression. And what that means in terms of our future studies is that we should work hard on determining whether preoperative. M. R. I. S. Are able to accurately identify patients with soul venus compression so that they may receive the appropriate patient preoperative counseling.