{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T04:15:17Z","timestamp":1782792917331,"version":"3.54.5"},"reference-count":98,"publisher":"Oxford University Press (OUP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Evaluation of neurovascular compression\u2013related trigeminal neuralgia (NVC-TN) and its resolution through microvascular decompression are demonstrable by MRI and intraoperatively [Leal et al. (Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes: Clinical article. J Neurosurg. 2014;120(6):1484-1495)]. Non-NVC-TNs treated by radiofrequency (RF) lack such detectable features.<\/jats:p>\n               <jats:p>Multimodal integration of pre-surgical diffusion tensor imaging (DTI) and volumetry (VOL) with intraoperative neurophysiology (ION) could improve understanding and performance of RF among non-NVC-TN.<\/jats:p>\n               <jats:p>We hypothesized that DTI disturbances\u2019 localization (central relay versus peripherally) rather than their values bares the most significant predictive value upon outcome and that ION could quantitatively both localize and assist RF of affected branches.<\/jats:p>\n               <jats:p>The first pre-surgical step evaluated the differences between affected and non-affected sides (by DTI and VOL). Four TN\u2019s segments were studied, from peripheral to central relay: Meckel\u2019s cave\u2013trigeminal ganglion (MC-TGN), cisternal portion, root entry zone (REZ) and spinal tract [Lin et al. (Flatness of the Meckel cave may cause primary trigeminal neuralgia: A radiomics-based study. J Headache Pain. 2021;22(1):104)]. In the second intraoperative step, we used both ION and patient\u2019s testimonies to confirm the localization of the affected branch, evolving hypoesthesia, pain reduction and monitoring of adverse effects [Sindou (Neurophysiological navigation in the trigeminal nerve: Use of masticatory responses and facial motor responses evoked by electrical stimulation of the trigeminal rootlets for RF-thermorhizotomy guidance. Stereotact Funct Neurosurg. 1999;73(1\u20134):117-121); Sindou and Tatli (Traitement de la n\u00e9vralgie trig\u00e9minale par thermorhizotomie. Neurochirurgie. 2009;55(2):203-210)]. Last and postoperatively, each data set\u2019s features and correlation with short-term (3 months) and long-term outcomes (23.5 \u00b1 6.7 months) were independently analysed and blind to each other. Finally, we designed a multimodal predictive model.<\/jats:p>\n               <jats:p>Sixteen non-NVC-TN patients (mean 53.6 \u00b1 SD years old) with mean duration of 6.56 \u00b1 4.1 years (75% right TN; 43.8% V3) were included. After 23.5 \u00b1 6.7 months, 14\/16 were good responders. Age, gender, TN duration and side\/branch did not correlate with outcomes.<\/jats:p>\n               <jats:p>Affected sides showed significant DTI disturbances in both peripheral (MC-TGNs) and central-relay (REZ) segments. However, worse outcome correlated only with REZ-located DTI disturbances (P = 0.04; r = 0.53). Concerning volumetry, affected MC-TGNs were abnormally flatter: lower volumes and surface area correlated with worse outcomes (both P = 0.033; r = 0.55 and 0.77, respectively). Intraoperatively, ION could not differ the affected from non-affected branch. However, the magnitude of ION\u2019s amplitude reduction (ION-\u0394-Amplitude) had the most significant correlation with outcomes (r = 0.86; P &amp;lt; 0.00006). It was higher among responders [68.4% (50\u201382%)], and a &amp;lt;40% reduction characterized non-responders [36.7% (0\u201340%)]. Multiple regression showed that ION-\u0394-Amplitude, centrally located only REZ DTI integrity and MC-TGN flatness explain 82.2% of the variance of post-RF visual analogue score.<\/jats:p>\n               <jats:p>Integration of pre-surgical DTI\u2013VOL with ION-\u0394-Amplitude suggests a multi-metric predictive model of post-RF outcome in non-NVC-TN. In multiple regression, central-relay REZ DTI disturbances and insufficiently reduced excitability (&amp;lt;40%) predicted worse outcome. Quantitative fine-tuned ION tools should be sought for peri-operative evaluation of the affected branches.<\/jats:p>","DOI":"10.1093\/braincomms\/fcae216","type":"journal-article","created":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T13:50:41Z","timestamp":1719409841000},"source":"Crossref","is-referenced-by-count":1,"title":["Multi-metric predictors of radiofrequency-treated trigeminal neuralgias"],"prefix":"10.1093","volume":"6","author":[{"given":"Liron","family":"Bayda","sequence":"first","affiliation":[{"name":"Assuta Medical Centre, Imaging Unit , 6971028 Tel Aviv , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Weinstein","sequence":"additional","affiliation":[{"name":"Assuta Medical Centre, Functional Neurosurgery Unit , 6971028 Tel Aviv , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexei","family":"Mirson","sequence":"additional","affiliation":[{"name":"Assuta Medical Centre, Functional Neurosurgery Unit , 6971028 Tel Aviv , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5298-4695","authenticated-orcid":false,"given":"Nir","family":"Getter","sequence":"additional","affiliation":[{"name":"Assuta Medical Centre, Functional Neurosurgery Unit , 6971028 Tel Aviv , Israel"},{"name":"Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev , 8410501 Be\u2019er Sheva , Israel"},{"name":"Department of Psychology and Education, The Open University of Israel , 4353701 Ra\u2019anana , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moshe","family":"Zer-Zion","sequence":"additional","affiliation":[{"name":"Assuta Medical Centre, Pain and Anaesthesia Unit , 6971028 Tel Aviv , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jehuda","family":"Sepkuty","sequence":"additional","affiliation":[{"name":"Assuta Medical Centre, Functional Neurosurgery Unit , 6971028 Tel Aviv , Israel"},{"name":"Neurology, Johns Hopkins University , Baltimore, MD 21218-2683 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikael","family":"Levy","sequence":"additional","affiliation":[{"name":"Assuta Medical Centre, Functional Neurosurgery Unit , 6971028 Tel Aviv , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,6,28]]},"reference":[{"issue":"6","key":"2024083010172545400_fcae216-B1","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.3171\/2014.2.JNS131288","article-title":"Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes: Clinical article","volume":"120","author":"Leal","year":"2014","journal-title":"J 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