2014 Outcome Predictors After Microvascular Decompression for Trigeminal Neuralgia: Expanding the Scope With MRI-Based Morphometric Analysis

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INTRODUCTION: Microvascular decompression (MVD) is an effective treatment for pain-relief in trigeminal neuralgia (TN) patients with vessel compression. Although several prognostic factors for pain relief outcomes have been studied, literature on MRI-based morphometrics is limited. METHODS: A retrospective chart review was performed for all patients who underwent MVD for TN at our institution from 2013-2024. Demographic data, procedural details, and Barrow Neurological index (BNI) pain were collected. MRI-based morphometric measurements were taken using Constructive interference in Steady State (CISS) MRI. These include trigeminal nerve (CNV) cisternal segment length and distances between CNV-CNVII, CNV-porus acusticus, and CNV-transverse-sigmoid sinus junction. Angle measurements were taken for CNV-anterior pons and CNV-midline. Regression models evaluated outcomes of initial post-op BNI score 3+ and last follow-up BNI score 3+. RESULTS: Our analysis included 179 patients with median BMI of 28.3 and age of 66.0 years at median follow-up of 6 months. Sex, laterality, pre-MVD numbness, hypertension, and prior balloon rhizotomy or gamma knife were not associated with BNI score of 3+. In univariate regression higher CNV length was associated with lower chance of BNI 3+, indicating better outcomes (p = 0.024). Multi-variate logistic regression showed significant association between increased CNV-Midline angle (p = 0.0017) and initial post-op BNI of 3+. Higher BMI and increased CNV-CNVII distance were associated with increased chance of BNI score 3+ on both initial (p = 0.0239 & p = 0.0053) and last follow-up (p = 0.0457 & p = 0.0164). CONCLUSIONS: Our study identifies predictors of pain outcomes following MVD for TN, including MRI-based morphometrics. Increasing CNV-CNVII distance and BMI were associated with worse initial and long-term pain outcomes, a greater CNV-midline angle correlated with higher initial post-op pain scores, and increasing CNV length correlated with improved long-term pain outcomes. These findings suggest morphometric and demographic factors may influence MVD efficacy, aiding patient selection and counseling.

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