The influence of neuroanatomy on treatment response of patients with trigeminal neuralgia

The influence of neuroanatomy on treatment response of patients with trigeminal neuralgia

Reviewed by Kate Anderton, B.Sc. (Editor) Jan 24 2020 A new study published in the journal Cephalalgia , the official journal of the International Headache Society, shows unprecedented data regarding the neuroanatomical influence on the treatment response of patients with trigeminal neuralgia. The study, entitled "Hippocampal and trigeminal nerve volume predict outcome of surgical treatment for trigeminal neuralgia", was conducted by Dr. Tejas Sankar's research group, from the University of Alberta, Canada. Trigeminal neuralgia (TG) is a facial pain in the lower portion of the face, mostly felt in the cheek next to the nose or in the jaw. According to the 3 rd Version of the International Classification of Headache Disorders - ICHD-3, TG is described as follows: "A disorder characterized by recurrent unilateral brief electric shock-like pains, abrupt in onset and termination, limited to the distribution of one or more divisions of the trigeminal nerve and triggered by innocuous stimuli. It may develop without apparent cause or be a result of another diagnosed disorder. Additionally, there may be concomitant continuous pain of moderate intensity within the distribution(s) of the affected nerve division(s)." The two most common forms of TN are non-lesional types, namely, the classic TN, associated with neurovascular compression of the nerve's root entry zone, and idiopathic TN, which occurs in the absence of neurovascular compression. Occasionally, TN may be due to lesions. Microvascular decompression is a neurosurgical procedure adopted as an alternative to patients refractory to pharmacological treatments. Based on previous data indicating that trigeminal nerve volume and cross-sectional area appear to be consistently reduced on the affected side in patients with TN, Dr. Sankar and his team hypothesized that TN patients who do not respond to surgical treatment could be characterized by distinct neuroanatomical features. Dr. Sankar's group assessed 37 classic or idiopathic TN patients. Neuroimaging obtained by T2-weighted magnetic resonance imaging (1.5T) was performed within the 12 months previously the microvascular decompression surgery. The trigeminal nerve, and subcortical brain structures involved in the trigeminal sensory relay (thalamus) or as potential contributors to limbic components of chronic pain (hippocampus, amygdala), were analyzed. They compared the ipsilateral and contralateral portions of the side of pain, total nerve volume (ipsilateral + contralateral), and % difference ((ipsilateral -contralateral/ipsilateral)100). Related Stories



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