Cerebrovascular neurosurgeon Risheng Xu recaps his presentation from the 2022 College of Neurological Surgeons annual meeting. His research on the sensitivity and specificity of MRI studies in predicting neurovascular compression offers recommendations for the standard workup for patients with trigeminal neuralgia who may be candidates for microvascular decompression.
Hello. My name is dr rushing shoe and I'm a cerebrovascular neurosurgeon at johns Hopkins Hospital. 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've presented at C. Ns 2022. Professional neuralgia is a highly debilitating disorder that can significantly impair quality of life. It's associated pain may manifest in many different forms ranging from electric shock like episodes through constant burning aches within the trigeminal distribution. In many of these cases, neurovascular conflict between the trigeminal nerve and superior sarah Bella artery leads to severe bouts of pain determining the presence of vascular compression may help neurosurgeons decide whether a microvascular decompression is the most appropriate surgery for patients. Magnetic resonance imaging is the standard preoperative imaging modality for these patients. And it's often used to detect not only vascular compression but also identify the potential presence of secondary ideologies of trigeminal neuralgia such as multiple sclerosis, tumors or other vascular malformations. However, despite increasing M. R. I. Magnetic strength and the development of specialized sequences such as the fiesta insists sequences imaging of cranial nerves and their sister Nall anatomy is still challenged by the realities of patient care such as involuntary patient movement during image acquisition or the inability to tolerate long acquisition times due to anxiety or pain excluding microvascular decompression candidates based on preoperative M. R. I imaging alone may prevent patients from achieving optimal pain relief and that is why in my laboratory we sought to determine the sensitivity and specificity of MRI's in their ability to predict neurovascular conflict in patients undergoing microvascular decompression. What we found in our experience is that in a total of over 900 patients who underwent high resolution preoperative M. R. I. With skull based sequences. This had a sensitivity of 75%, a specificity of 67% with a positive predictive value of 92% and a negative predictive value of 33% in predicting trigeminal nerve neurovascular compression separately. We also looked at non high resolution M. R. E. S. And surprisingly this showed a pretty good sensitivity of 79%. However, the specificity was only 50% which corresponded to a positive predictive value of around 90% with a negative predictive value of only 30%. What this means for us is that a preoperative M. R. I may offer a high predictive value for neurovascular conflict and should be a part of the standard preoperative care work up for every trigeminal neuralgia patient. However, the lack of neurovascular conflict on preoperative imaging should not be sufficient to exclude patients from undergoing a microvascular decompression.
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