治疗前 DTI 标记:预测微血管减压术治疗典型三叉神经痛的临床效果--系统综述。

IF 2.5 3区 医学 Q2 CLINICAL NEUROLOGY
Giuseppe Pio Cipollina, Roberta Costanzo, Benedetta Maria Campisi, Gianluca Scalia, Lara Brunasso, Lapo Bonosi, Domenico Gerardo Iacopino, Rosario Maugeri
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引用次数: 0

摘要

背景和目的:三叉神经痛(TN)是一种严重的慢性疼痛,通常影响 50 岁以上的患者,由血管压迫神经根入口区(REZ)引起。虽然临床诊断是关键,但弥散张量成像(DTI)等先进成像技术对于确定潜在病因和评估神经损伤至关重要。DTI 可能有助于开发神经影像标记物,从而加深对 TN 的理解并预测手术效果。本系统综述的目的是评估 DTI 和束流成像的有效性,以便通过分析三叉神经的改变更好地评估治疗计划和疗效预测:作者对文献进行了系统综述和荟萃分析,比较了术前和术后 MRI 与 DTI 序列确定的放射学参数,包括分数各向异性(FA)、各向异性量(QA)、径向扩散率(RD),并将这些结果与术后临床结果进行了关联分析。我们对 PubMed 和 Scopus 数据库中 2010 年 4 月至 2024 年 1 月间发表的研究进行了全面检索:结果:本综述包括 11 项研究和 603 名患者。在363名三叉神经痛(TN)患者中,有193人接受了微血管减压术(MVD),其中72.5%的患者临床症状有所改善,27.5%的患者没有改善,这可能是由于慢性神经损伤所致。四项研究评估了 MVD 前后的放射学参数,两项研究只关注 MVD 后的数据。受影响神经的平均分数各向异性(FA)从 MVD 前的 0.328 增加到 MVD 后的 0.382。五项研究没有报告术后结果,只是比较了TN患者与健康对照组的放射学参数:最近的研究表明,MRI-DTI 参数(包括 FA、RD 和 QA)有助于诊断三叉神经痛和预测治疗效果。较低的 FA 值和较高的 RD 值预示着手术后的效果更好。必须开展更多的研究,以指导治疗决策并加强对患者的护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pre-treatment DTI markers: predicting clinical outcomes in microvascular decompression for classic trigeminal neuralgia - a systematic review.

Background and purpose: Trigeminal neuralgia (TN) is a severe chronic pain condition, typically affecting patients over 50-year-old, caused by the compression of the nerve at the root entry zone (REZ) by blood vessels. While the diagnosis is clinical, advanced imaging like diffusion tensor imaging (DTI) is crucial to identify underlying causes and assessing nerve damage. DTI may help develop neuroimaging markers to improve understanding of TN and predict surgical outcomes. The goal of the present systematic review is to evaluate the effectiveness of DTI and tractography in order to better assess treatment planning and outcome prediction through the analysis of trigeminal nerve alterations.

Methods: The authors conducted a systematic review and meta-analysis of the literature to compare radiological parameters identified in pre- and post-operative MRI with DTI sequences, including fractional anisotropy (FA), quantity of anisotropy (QA), radial diffusivity (RD), and to correlate these findings with post-operative clinical outcomes. A comprehensive search of the PubMed and Scopus databases was carried out for studies published between April 2010 and January 2024.

Results: This review included 11 studies and 603 patients. Of the 363 patients with trigeminal neuralgia (TN), 193 underwent microvascular decompression (MVD), with 72.5% showing clinical improvement and 27.5% not improving, possibly due to chronic nerve damage. Four studies assessed radiological parameters before and after MVD, while two focused only on post-MVD data. The mean fractional anisotropy (FA) in affected nerves increased from 0.328 before MVD to 0.382 afterward. Five studies did not report postoperative outcomes, just comparing radiological parameters in TN patients versus healthy controls.

Conclusions: Recent studies show that MRI-DTI parameters, including FA, RD, and QA, are useful for diagnosing trigeminal neuralgia and predicting treatment outcomes. Lower FA and higher RD values indicate better results after surgery. More research is mandatory to guide treatment decisions and enhance patients' care.

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来源期刊
Neurosurgical Review
Neurosurgical Review 医学-临床神经学
CiteScore
5.60
自引率
7.10%
发文量
191
审稿时长
6-12 weeks
期刊介绍: The goal of Neurosurgical Review is to provide a forum for comprehensive reviews on current issues in neurosurgery. Each issue contains up to three reviews, reflecting all important aspects of one topic (a disease or a surgical approach). Comments by a panel of experts within the same issue complete the topic. By providing comprehensive coverage of one topic per issue, Neurosurgical Review combines the topicality of professional journals with the indepth treatment of a monograph. Original papers of high quality are also welcome.
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