Incidence, role, and imaging-based diagnostic accuracy of neurovascular compression in trigeminal neuralgia: a longitudinal cohort study.

Introduction: Neurovascular compression (NVC) often drives trigeminal neuralgia (TGN) pathology. This study examines the incidence, diagnostic accuracy, and role of NVC.

Methods: We conducted a retrospective review of patients ≥18 years with medically refractory TGN who underwent MRI, plus a secondary cohort of medically responsive patients. All had ≥1-year follow-up. MRI scans were interpreted by a general radiologist (initial) and neuroradiologist (final), with the latter used to determine NVC. Patients were grouped as: no NVC (NC), NVC on symptomatic side (SC), and bilateral NVC (BC). Statistical tests included Shapiro-Wilk, paired T-test, ANOVA, and Log-Rank; The Barrow-Neurological Institute (BNI) scale quantified severity.

Results: Among 459 patients, 168, 213, and 78 had NC, SC, and BC respectively. Interpretation congruence on the symptomatic side was significantly different (p < 0.01). BC patients had lower median BNI at diagnosis (BNI = 3, p = 0.0018) and more frequent sensory deficits (50%, p = 0.0006). KM analysis showed significant differences in median recurrence: NC (7.1 months), SC (9.0 months), BC (10.0 months), AC (15.8 months). SC patients were less likely to have refractory TGN (OR = 0.6622, p = 0.0064), while NC patients were more likely (OR =1.469, p = 0.0091).

Conclusion: Findings reveal interpretation errors and suggest increased blinding. NC patients had more refractory TGN; BC patients had reduced severity.