Comparison of sagittal angle of trigeminal nerve at porus trigeminus between responders and non-responders to microvascular decompression surgery in patients with trigeminal neuralgia.
Shehbaz Ansari, Brian H Mu, Eric R Basappa, Melih Akyuz, Miral D Jhaveri, Santhosh Gaddikeri
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Abstract
Background and purpose: 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.
Materials and methods: 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.
Results: 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.
Conclusions: 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.
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