Study On The Correlation Of Trigeminal MRI Morphology With Clinical Manifestations And PRT Prognosis

Objective:To retrospectively analyze the morphology factors of trigeminal nerve in 95 patients with idiopathic trigeminal neuralgia(ITN),and to explore its correlation with the clinical manifestations of idiopathic trigeminal neuralgia and the prognosis of percutaneous radiofrequency thermocoagulation(PRT).Methods:Collected clinical records and MRI image data of 95 patients with ITN admitted to the Department of Pain,Second Affiliated Hospital of Guangxi Medical University from January 2018 to August 2019 and underwent PRT,and obtained general information such as age,gender,side of disease,involvement of trigeminal nerve branches,course of disease,NRS pain scores,past history and the relationship between blood vessels and nerves.Multi-planar reconstruction of MRI images on the ADW4.5 workstation,measured morphological factors such as the length of the trigeminal nerve roots,the cross-sectional area of the trigeminal nerve roots,trigeminal-pontine angle,the crossover apex angle of the trigeminal nerve,and calculated the atrophy degree of trigeminal nerve root.Long term effect information of patients after PRT was obtained by telephone follow-up.The paired sample t-test were used to compare the difference of the trigeminal nerve morphological factors between the symptomatic side and the asymptomatic side.Kruskal-wails test was used to compare the differences of atrophy degree of trigeminal nerve root between different characteristics of vascular nerve relationship.The Spearman correlation analysis was used to determine the relationship between the morphology and the NRS score,χ~2-test,t-test of two independent samples and Mann-Whitney U test were used to compare the differences of prognosis in general condition data and morphology,and logistic multiple factor regression analysis was used to evaluate the independent risk factors affecting the prognosis of PRT.Results:The results of paired sample t-test showed that the trigeminal root cross-sectional area and trigeminal-pontine angle on the symptomatic side of ITN patients were significantly smaller than those on the asymptomatic side(P<0.05),and the trigeminal root length and trigeminal nerve angle across the petrous tip on both sides had no significant difference(P>0.05);Kruskal-wails test showed that the difference of atrophy degree of trigeminal nerve root in compression group was greater than that in contact/suspicious contact group and no contact group(P<0.05);Spearman correlation analysis showed that there was a negative correlation between trigeminal-pontine angle and NRS(r=-0.206,P=0.045<0.05),there was no correlation between NRS score and the atrophy degree of trigeminal nerve root,trigeminal nerve angle across the petrous tip,trigeminal root length,relationship between blood vessels and nerves(P>0.05);By single factor analysis and binary logistic regression analysis,the course of disease(OR=2.834,P=0.047<0.05)was an independent risk factor for recurrence after PRT.Age,gender,lesion side,trigeminal nerve branch involved,baseline pain degree,relationship between blood vessel and nerve location,atrophy degree of trigeminal nerve root,trigeminal-pontine angle,trigeminal nerve angle across the petrous tip had no effect on prognosis.Conclusions:1.reduced trigeminal-pontine angle and reduced cross-sectional area of trigeminal nerve root have certain reference value for the diagnosis of ITN;2.The angle of pontine nerve is correlated with NRS score;3.Relationship between blood vessel and nerve location,atrophy degree of trigeminal nerve root,trigeminal nerve length,trigeminal-pontine angle,trigeminal nerve angle across rock tip have no significant effect on the prognosis of PRT,and the duration of the disease is closely related to the prognosis of PRT.