Correlation of Preoperative High-Resolution Neurovascular Imaging and Surgical Success in Neurovascular Compression Syndromes

Shaye Busse; Justin Taylor; Melvin Field

doi:10.1016/j.wneu.2023.01.094

Correlation of Preoperative High-Resolution Neurovascular Imaging and Surgical Success in Neurovascular Compression Syndromes

World Neurosurg. 2023 Apr:172:e593-e598. doi: 10.1016/j.wneu.2023.01.094. Epub 2023 Jan 31.

Authors

Shaye Busse¹, Justin Taylor², Melvin Field³

Affiliations

¹ Department of Neurosurgery, University of Central Florida College of Medicine, Orlando, Florida, USA.
² Department of Neurosurgery, University of Central Florida College of Medicine, Orlando, Florida, USA. Electronic address: justintaylor@knights.ucf.edu.
³ Department of Neurosurgery, University of Central Florida College of Medicine, Orlando, Florida, USA; Orlando Neurosurgery, Winter Park, Florida, USA.

PMID: 36731774
DOI: 10.1016/j.wneu.2023.01.094

Abstract

Background: Neurovascular compression syndromes (NVCSs) are a group of neurological disorders characterized by compression of a cranial nerve and include trigeminal neuralgia (TN), hemifacial spasm, geniculate neuralgia, glossopharyngeal neuralgia, vestibular paroxysmia, and trochlear palsy. The European Academy of Neurology recommends constructive interference in steady-state/fast imaging employing steady-state (CISS/FIESTA) magnetic resonance imaging (MRI) in the evaluation of medically intractable TN, but similar recommendations do not exist for the remaining NVCSs.

Methods: We conducted a retrospective chart review of 300 patients with an NVCS who underwent microvascular decompression (MVD) by a single neurosurgeon from 2004 to 2021. Data were collected on preoperative diagnosis, pre- and postoperative symptoms, presence/absence of preoperative high-spatial-resolution CISS/FIESTA MRI, and intraoperative findings. Rates of symptomatic improvement were used as a correlate of surgical success.

Results: The rate of symptomatic improvement in the patients with a preoperative CISS/FIESTA MRI was 5.8% greater than those without preoperative high-spatial-resolution neuroimaging (98.8% vs. 93%, respectively; P = 0.008). Stratified by diagnosis, patients with TN had the greatest difference in surgical success between the 2 groups (99.3% vs. 92.9%, n = 268; P = 0.006). No statistically significant differences were observed in the other NVCSs, although positive trends were noted.

Conclusions: Preoperative CISS/FIESTA MRI correlated with greater rates of surgical success in cases of medically intractable TN; however, definitive conclusions could not be made regarding the remaining NVCSs. We support the recommendation that this imaging modality be included as part of the standard of practice for the evaluation and management of TN and encourage future studies to further elucidate this relationship for the less common NVCSs using a larger cohort.

Keywords: CISS/FIESTA MRI; Glossopharyngeal neuralgia; Hemifacial spasm; Microvascular decompression; Neurovascular compression syndrome; Trigeminal neuralgia; Vestibular paroxysmia.

MeSH terms

Cranial Nerves / surgery
Humans
Magnetic Resonance Imaging / methods
Microvascular Decompression Surgery*
Nerve Compression Syndromes* / diagnostic imaging
Nerve Compression Syndromes* / surgery
Retrospective Studies
Trigeminal Neuralgia* / diagnostic imaging
Trigeminal Neuralgia* / surgery