sibmedСибирский научный медицинский журналСибирский научный медицинский журнал2410-25122410-2520ИЦиГ СО РАН10.18699/SSMJ20240517sibmed-1716Research ArticleКЛИНИЧЕСКАЯ МЕДИЦИНАCLINICAL MEDICINEПредикторы успешной операции микроваскулярной декомпрессии у пациентов с классической невралгией тройничного нерва по данным нейровизуализацииPredictors of successful microvascular decompression surgery in patients with classical trigeminal neuralgia according to the neuroimaging datahttps://orcid.org/0009-0003-3739-8438АлзиралхусейниА. Ф.AlzeeralhouseiniA. F.

Альзиралхаусини Абедалла Ф.

630091, г. Новосибирск, Красный пр., 52

Abedallah F. Alzeeralhouseini

630091, Novosibirsk, Krasny ave., 52

abedallahalhussini@gmail.comhttps://orcid.org/0000-0002-3885-3004МойсакГ. И.MoisakG. I.

Мойсак Галина Ивановна, к.м.н.

630091, г. Новосибирск, Красный пр., 52

630087, г. Новосибирск, ул. Немировича-Данченко, 132/1

630090, г. Новосибирск, ул. Пирогова, 1

Galina I. Moisak, candidate of medical sciences

630091, Novosibirsk, Krasny ave., 52

630087, Novosibirsk, Nemirovicha-Danchenko st., 132/1

630090, Novosibirsk, Pirogova st., 1

g_moysak@neuronsk.ruhttps://orcid.org/0000-0002-6696-9071ФилимоноваЕ. А.FilimonovaE. A.

Филимонова Елена Андреевна

630091, г. Новосибирск, Красный пр., 52

630087, г. Новосибирск, ул. Немировича-Данченко, 132/1

Elena A. Filimonova

630091, Novosibirsk, Krasny ave., 52

630087, Novosibirsk, Nemirovicha-Danchenko st., 132/1

e_filimonova@neuronsk.ruhttps://orcid.org/0000-0002-1209-8960РзаевД. А.RzaevJ. A.

Рзаев Джамиль Афетович, д.м.н., проф.

630091, г. Новосибирск, Красный пр., 52

630087, г. Новосибирск, ул. Немировича-Данченко, 132/1

630090, г. Новосибирск, ул. Пирогова, 1

Jamil A. Rzaev, doctor of medical sciences, professor

630091, Novosibirsk, Krasny ave., 52

630087, Novosibirsk, Nemirovicha-Danchenko st., 132/1

630090, Novosibirsk, Pirogova st., 1

jamilrzaev@gmail.comНовосибирский государственный медицинский университет Минздрава РоссииРоссияNovosibirsk State Medical University of Minzdrav of RussiaRussian FederationНовосибирский государственный медицинский университет Минздрава России ; Федеральный центр нейрохирургии Минздрава России ; Новосибирский государственный университетРоссияNovosibirsk State Medical University of Minzdrav of Russia ; Novosibirsk Center of Neurosurgery of Minzdrav of Russia ; Novosibirsk State UniversityRussian FederationНовосибирский государственный медицинский университет Минздрава России ; Федеральный центр нейрохирургии Минздрава РоссииРоссияNovosibirsk State Medical University of Minzdrav of Russia ; Novosibirsk Center of Neurosurgery of Minzdrav of RussiaRussian Federation202430102024445145154Copyright © Алзиралхусейни А.Ф., Мойсак Г.И., Филимонова Е.А., Рзаев Д.А., 20242024Алзиралхусейни А.Ф., Мойсак Г.И., Филимонова Е.А., Рзаев Д.А.Alzeeralhouseini A.F., Moisak G.I., Filimonova E.A., Rzaev J.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://sibmed.elpub.ru/jour/article/view/1716

Тригеминальная невралгия представляет значительные трудности в нейрохирургии, при этом пациенты по-разному реагируют на микроваскулярную декомпрессию (МВД). Современные методы нейровизуализации, в частности МРТ с использованием последовательности constructive interference in steady state (CISS) и diffusion tensor imaging (DTI), стали перспективными инструментами для прогнозирования исходов МВД. Целью исследования было определить нейровизуализационные предикторы успешной МВД у пациентов с классической невралгией тройничного нерва. Материал и методы. В данном ретроспективном исследовании проанализировано 58 пациентов, перенесших МВД по поводу классической невралгии тройничного нерва в Федеральном нейрохирургическом центре (Новосибирск, Россия) в период с января 2017 г. по декабрь 2021 г. Исходы оценивались по шкале интенсивности тригеминальной боли Института неврологии Бэрроу (Barrow Neurological Institute (BNI) score for trigeminal neuralgia). Для оценки выраженности нейроваскулярного конфликта, диффузии нервов и других параметров использовалась дооперационная нейровизуализация с CISS и DTI. Результаты. 79,3 % (BNI I и II) пациентов практически не испытывали боли после операции, из них 65,5 % (BNI I) успешно полностью восстановились после процедуры без боли, а 13,8 % (BNI II) имели хороший исход. В ходе исследования выявлена значительная корреляция между благоприятными исходами МВД и более высокими оценками 2 и 3 по шкале Sindou, что свидетельствует о более тяжелом нейроваскулярном конфликте (p < 0,001). Также значимые различия наблюдались в исходах в зависимости от значений фракционной анизотропии на симптомном нерве (p = 0,029). Обсуждение. Анатомические факторы, измеренные с помощью МРТ, имели ограниченное влияние на исходы, в то время как градация по шкале Sindou показала значительную корреляцию с хирургическими исходами, а более высокие значения фракционной анизотропии были связаны с худшими исходами. Заключение. Изучение нейровизуализационных предикторов исходов операции МВД у пациентов с невралгией тройничного нерва, полученных на основе CISS-последовательности визуализации и DTI до лечения, свидетельствует о важности оценки тяжести сосудистой компрессии при планировании хирургического вмешательства и прогностической ценности значений фракционной анизотропии по данным DTI для предоперационной оценки.

Trigeminal neuralgia presents significant challenges in neurosurgery, with patients responding variably to Microvascular Decompression (MVD). Advanced neuroimaging techniques, specifically MRI using the Constructive Interference in Steady State (CISS) sequence and Diffusion Tensor Imaging (DTI), have emerged as promising tools in predicting the outcomes of MVD. Aim of the study was to determine neuroimaging predictors of successful microvascular decompression surgery in patients with classical trigeminal neuralgia. Material and methods. This retrospective study analyzed 58 patients who underwent microvascular decompression for classical trigeminal neuralgia at the Federal Neurosurgical Center in Novosibirsk, Russia, between January 2017 and December 2021. Outcomes were assessed by the Barrow Neurological Institution (BNI) scale. Preoperative neuroimaging with CISS and DTI was used to evaluate neurovascular conflict severity, nerve diffusion and other criteria. Results. 79.3 % (BNI I & II) of patients were practically free of pain postoperatively, in which 65.5 % (BNI I) had successfully completely recovered from the procedure with no pain, and 13.8 % (BNI II) had a good outcome. And the study found a significant correlation between favorable MVD outcomes and higher Sindou grades 2 and 3, indicating more severe neurovascular conflict (p < 0.001). Also significant differences were observed in outcomes based on fractional anisotropy values on symptomatic nerve (p = 0.029). Discussion. Anatomical factors which measured by MRI had limited impact on outcomes, while Sindou grading showed a significant correlation with surgical outcomes, and higher fractional anisotropy values were associated with poorer outcomes. Conclusions. The investigation of neuroimaging predictors for MVD surgery outcomes in patients with trigeminal neuralgia, received from CISS-sequence imaging and pre-treatment DTI, indicates the importance of estimation of severity of vascular compression in surgical planning and the predictive value of fractional anisotropy values from DTI for preoperative assessments.

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The authors declare that there are no conflicts of interest present.