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S007: OUTCOME PREDICTORS AFTER MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA: EXPANDING THE SCOPE WITH MRI-BASED MORPHOMETRIC ANALYSIS
Shadi Bsat, MD¹; Saahas Rajendran, BS²; Mohammadmahdi Sabahi, MD, MPH¹; Serdar Rahmanov, MD¹; Kaylee Sarna, MS¹; Badih Adada, MD¹; Hamid Borghei-Razavi, MD¹; ¹Cleveland Clinic Florida; ²Charles E. Schmidt College of Medicine at Florida Atlantic University

Objective: Microvascular decompression (MVD) is an effective treatment for pain-relief in trigeminal neuralgia (TN) patients with vessel compression. Although several prognostic factors for pain relief outcomes have been studied, literature on MRI-based morphometrics is limited. Our study analyzes outcome predictors, including MRI measurements, for MVD.

Methods: A retrospective chart review was performed for all patients who underwent MVD for TN at our institution from 2013-2024. Demographic data, procedural details, and Barrow Neurological Index (BNI) pain scale were collected. MRI-based morphometric measurements were taken  using  Constructive Interference in Steady State (CISS) MRI. These include trigeminal nerve (CN V) cisternal segment length and distances between CN V-CNVII, CN V-porus acusticus, and CN V-transverse-sigmoid sinus junction. Angle measurements were taken for CN V-anterior pons and CN V-midline. Regression models evaluated outcomes of initial post-op BNI score ≥3 and last follow-up BNI score ≥3.

Results: Our analysis included 179 patients with median BMI of 28.3 and age of 66.0 years at median follow-up of 6 months. Sex, laterality, pre-MVD numbness, hypertension, and prior balloon rhizotomy or gamma knife were not associated with BNI score of ≥3. In univariable regression, higher CN V length was associated with lower chance of BNI ≥3, indicating better outcomes (p=0.024). Multivariable logistic regression showed significant association between increased CNV-Midline angle (p=0.0017) and initial post-op BNI of ≥3. Higher BMI and increased CN V-CNVII distance were associated with increased chance of BNI score ≥3 on both initial (p=0.0239 & p=0.0053) and last follow-up (p=0.0457 & p=0.0164). In the subgroup that excluded patients with prior non-medical interventions and any non-vascular compression, every predictor that was significant in the full cohort stayed significant except the CN?VII-CN?V distance for the initial post-op BNI outcome. In the arterial compression only subgroup, BMI emerged as the lone significant predictor of initial post-op BNI≥3, while CN?VII-CN?V distance was the single significant predictor at last follow-up.

Conclusion: Our study identifies predictors of pain outcomes following MVD for TN, incorporating MRI-based morphometrics. After controlling for confounding factors, we found that a greater CN V–CN VII distance was associated with worse initial and long-term pain outcomes, a larger CN V–midline angle correlated with higher immediate postoperative pain scores, and increased CN V length was linked to improved long-term outcomes. These findings suggest that both morphometric and demographic factors may influence MVD efficacy, providing valuable insights for patient selection and counseling.

 

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