Transcript: Should trigeminal neuralgia patients get neuroimaging? A neurosurgeon’s perspective

Came across this today…

http://www.facepain.us/linskey_should%20trigeminal%20neuralgia%20patients%20get%20neuroimaging.html

Make sure you scroll through, it is longer than it appears…

Very good video ( and transcript). The Dr make very good points, especially that the neurosurgeon needs to do the interpretation of the MRI. The radiologist who did mine noted a slight compression. The Neurosurgeon who looked at it thought otherwise. In fact there were 8 compressions of the nerve that my surgeon remedied when I had my MVD. Something is causing the TN and sometimes its not found until the neurosurgeon is, "on site", so to speak.

It is critically important that MVD candidates assess the experience and skill of their neurosurgeon and the facility where the surgery is done.Thanks for sharing this fine piece Mimi.

Best,

Rick

Very interesting!! Thankyou for sharing this.

Very interesting video. I recently had a second MRI and the neuro just read the radiologists report. He didn't seem to fully understand it. This new neuro doesn't even look at the scan himself. <major frown> I heard him tell someone he doesn't have a way to look at it. Um, I have an old laptop and I look at all of my MRI's, lol. I don't know how to read them but I sure do like to take a look at what my brain, neck and back look like.

Anyways, this video spurred me to think about getting a second opinion from a neurosurgeon to know what is going on in there.

Please don't THINK about getting a second opinion. Please DO IT. You need someone experienced with TN and at reading MRI's of this anatomy. .On this site are listings for Dr's who can do this, hopefully near you. Good luck

I had MRI done in remission, requested it out of fear after bad and long episode and consultant decided to go with it. It was done around ten years after my neuralgia started. There appeared to be slight compression, what's interesting, on the other side from which I experience attacks. My first question was of course 'am I to expect attacks on the right side in the future?' I was reassured that not necessarily and so far, luckily, there were no incidents on the right side.

I totally agree. Get a second opinion or even a third.



RickRI said:

Please don't THINK about getting a second opinion. Please DO IT. You need someone experienced with TN and at reading MRI's of this anatomy. .On this site are listings for Dr's who can do this, hopefully near you. Good luck

You should get a "targeted" MRI to see where the nerve damage is. Not at all hospitals have this, you need to find out if there are any in your areas that do this. I had an MRI and an MRI w/contrast and they did not show anything. Also, you need a competent radiologist and neurologist to look at the results.

“(The truth is that 2/3’s of patients have more than one blood vessel compressing and you only see that at surgery. MRI rarely shows more than one. So when it doesn’t show any, that doesn’t mean there isn’t a blood vessel there.)

In scientific terms, we say that it’s positive predictive value is good, it’s negative predictive value is terrible, and it’s sensitivity is poor. So, be careful of that.”

I think there's a little something in transcript that could be corrected.

When Dr Linskey says about positive predictive value, negative predictive value and sensitivity, in my understanding he is referring to MRI's, and that would be:

'its positive predictive value is good'; if you see blood vessel on MRI, it's there

'its negative predictive value is terrible'; if you can't see blood vessel on MRI, you don't know (which is terrible)

'its sensitivity is poor'; if you can't see blood vessel on MRI, it might not be there, however, you don't know if it's not there, it might be there even though you can't see it.