Predictive value of MRI for identifying symptomatic neurovascular compressions in classical trigeminal neuralgia: A PRISMA-compliant meta-analysis

Abstract

Abstract Background Patients with trigeminal neuralgia frequently undergo magnetic resonance imaging (MRI) prior to surgery. In patients without the signs and symptoms of face discomfort, MRI has shown the presence of neurovascular contact (NVC) in humans. Therefore, its capacity to accurately exclude NVC of the trigeminal nerve is not properly understood. A meta-analysis of the literature satisfied the criteria to further explore the value of MRI for the diagnosis of classical trigeminal neuralgia (CTN). Study Design The association between the symptomatic and asymptomatic trigeminal nerves, NVC, root entry zone (REZ), non-REZ, and anatomical variation was measured by a comprehensive review and meta-analysis of 13 observational studies using MRI for CTN neurovascular compression diagnosis. Objectives This study aimed to evaluate the effectiveness of MRI in detecting the neurovascular compression that causes symptoms in individuals with classic trigeminal neuralgia. Setting This study was conducted at the Department of Neurosurgery, Yantai Yuhuangding Hospital, Qingdao University. Methods Digital searches of PubMed, Embase, and the Cochrane Library were performed to identify studies published until December 31, 2022. The following were evaluated: 1) MRI evidence of NVC in symptomatic and asymptomatic trigeminal nerves; 2) MRI indication of NVC at the REZ in symptomatic and asymptomatic trigeminal nerves; 3) MRI substantiation of non-REZ neurovascular contact in patients with CTN; and 4) asymptomatic and symptomatic anatomical changes at the NVC site of the trigeminal nerves. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the fixed effects models. Results Thirteen observational studies were analyzed. First, MRI of 88.2% of symptomatic versus 36.3% of asymptomatic trigeminal nerves revealed marked differences in NVC in the REZ. Second, pooled data showed that REZ NVC was detected in 78.6% of symptomatic and 37.9% of asymptomatic nerves. Third, MRI analysis of NVC in the non-REZ revealed no differences between 12.1% asymptomatic nerves and 16.5% symptomatic nerves, and MRI revealed marked differences in 53.2% symptomatic and 7.9% asymptomatic anatomic changes at the NVC site of the trigeminal nerve. Limitations Despite the systematic evaluation of 13 observational studies, large-scale randomized controlled trials should be conducted, focusing on the specificity of MRI for the diagnosis of trigeminal neuralgia and evaluating the specificity of the imaging findings and the impact of the patient's postoperative treatment. Conclusions A previous meta-analysis showed that patients with CTN were more likely to have NVC-specific anatomical changes. MRI of patients with CTN can detect anatomical changes in the REZ NVC with higher sensitivity.