Trigeminal neuralgia without neurovascular compression presents earlier than trigeminal neuralgia with neurovascular compression
AL Ko, A Lee, AM Raslan, A Ozpinar, S McCartney… - Journal of Neurosurgery, 2015
… Further research into the pathophysiology underlying this debilitating disease is needed. … In our
study, the proportion of female to male patients without NVC was 2.9:1; however, other studies
have reported more dramatic findings, with 6:1 and even 20:1 ratios. …
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Trigeminal neuralgia without neurovascular compression presents earlier than trigeminal neuralgia with neurovascular compression
Andrew L. KoMD1, Albert LeeMD2, Ahmed M. RaslanMD1, Alp OzpinarBA1, Shirley McCartneyPhD1 and Kim J. BurchielMD1
1Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and 2Department of Neurological Surgery, University of Indiana, Indianapolis, Indiana
Correspondence Kim J. Burchiel, Department of Neurological Surgery, Oregon Health & Science University, mail code: CH8N, 3303 SW Bond Ave., Portland, OR 97239. email: ■■■■■■■■■■■■■■■■■.
INCLUDE WHEN CITING Published online June 5, 2015; DOI: 10.3171/2014.11.JNS141741.
DISCLOSURE The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Journal of Neurosurgery
Pages. 1-9
(Volume publication date: June 2015)
DOI: 10.3171/2014.11.JNS141741
OBJECT
Trigeminal neuralgia (TN) occurs and recurs in the absence of neurovascular compression (NVC). To characterize what may be distinct patient populations, the authors examined age at onset in patients with TN with and without NVC.
METHODS
A retrospective review of patients undergoing posterior fossa surgery for Type I TN at Oregon Health & Science University from 2009 to 2013 was undertaken. Charts were reviewed, and imaging and operative data were collected for patients with and without NVC. Mean, median, and the empirical cumulative distribution of onset age were determined. Statistical analysis was performed using Student t-test, Wilcoxon and Kolmogorov-Smirnoff tests, and Kaplan-Meier analysis. Multivariate analysis was performed using a Cox proportional hazards model.
RESULTS
The charts of 219 patients with TN were reviewed. There were 156 patients who underwent posterior fossa exploration and microvascular decompression or internal neurolysis: 129 patients with NVC and 27 without NVC. Mean age at symptoms onset for patients with and without NVC was 51.1 and 42.6 years, respectively. This difference (8.4 years) was significant (t-test: p = 0.007), with sufficient power to detect an effect size of 8.2 years. Median age between groups with and without NVC was 53.25 and 41.2 years, respectively (p = 0.003). Histogram analysis revealed a bimodal age at onset in patients without NVC, and cumulative distribution of age at onset revealed an earlier presentation of symptoms (p = 0.003) in patients without NVC. Chi-square analysis revealed a trend toward female predominance in patients without NVC, which was not significant (p = 0.08). Multivariate analysis revealed that age at onset was related to NVC but not sex, symptom side or distribution, or patient response to medical treatment.
CONCLUSIONS
NVC is neither sufficient nor necessary for the development of TN. Patients with TN without NVC may represent a distinct population of younger, predominantly female patients. Further research into the pathophysiology underlying this debilitating disease is needed.
Keywords: trigeminal neuralgia; neurovascular compression; age at symptom onset; microvascular decompression; peripheral nerve; pain
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