Trigeminal Nerve Compression Without Trigeminal Neuralgia: Intraoperative vs Imaging Evidence

Area of Science:

• Neurosurgery
• Diagnostic Imaging

Background:

• High-resolution imaging is increasingly used for surgical decisions in trigeminal neuralgia.
• Direct assessment of vascular contact with the trigeminal nerve remains the gold standard for surgical intervention decisions.

Purpose of the Study:

• To compare intraoperative findings with magnetic resonance imaging (MRI) for the prevalence and severity of vascular compression of the trigeminal nerve.
• To evaluate neurovascular contact/compression (NVC/C) in patients without classical trigeminal neuralgia.

Main Methods:

• Prospective recruitment of 27 patients without facial pain undergoing microvascular decompression for hemifacial spasm.
• High-resolution preoperative MRI and intraoperative assessment of NVC/C, stratified into contact, compression, and deformity.

Main Results:

• Intraoperative NVC/C detected in 23 patients; MRI detected NVC/C in 18 patients (28% more cases intraoperatively).
• Agreement on NVC/C severity between methods was 83% when both detected NVC/C.
• No nerve deformity was observed by either method.

Conclusions:

• Moderate agreement exists between MRI and intraoperative findings regarding the presence and severity of neurovascular contact/compression.
• Intraoperative assessment offers a higher detection rate for NVC/C compared to MRI in this patient group.