Diffuse Tensor Imaging Changes of Trigeminal Nerve in Trigeminal Neuralgia Patients Receiving Percutaneous Radiofrequency Rhizotomy Chih-Hao Kao MD; Jen-Tsung Yang; Martin Hsiu-Chu Lin; Yuan-Hsiung Tsai; Ming-Hsueh Lee; Wei-Chao Huang; Ping-Jui Tsai; Yu-Jen Kuo; Wei-Yuan Cheng Department of Neurosurgery, Chang Gung Memorial Hospital-Chiayi

Results Introduction Learning Objectives Table 1 Trigeminal Neuralgia is a common Percutaneous radiofrequency By the conclusion of the study, we rhizotomy significantly increased the chronic cranial-facial pain disorder. can identify the image changes in volume (72.73±14.88 vs We previously reported that diffuse 83.88±21.92mm3, p=0.04), fractional trigeminal nerves after tensor imaging (DTI) could be anisotropy (0.273±0.094 vs radiofrequency rhizotomy in Differences in DTI metrics between pre- applied to assess the microstructural 0.310±0.049, p=0.05 ), and trigeminal neuralgia patients. The rhizotomy and post-rhizotomy of trigeminal changes in the affected trigeminal decreased in apparent diffusion change may indicate there's nerve (N=33) coefficient (1.61±0.25x10-3 vs nerve. In this study, the relationships difference in signal conduction in the 1.47±0.20x10-3mm2/s, p=0.009), Figure 1 between DTI changes before and radial diffusivity (1.52±0.29x10-3 vs nerve, and therefore pain is after percutaneous radiofrequency 1.38±0.18x10-3mm2/s, p=0.009) and resolved. However, the image rhizotomy, intraoperative rhizotomy mean diffusivity (1.26±0.30x10-3 vs change could not be correlated with needle position, and postoperative 1.10±0.19x10-3mm2/s, p=0.004) of clinical outcome in our study. We the trigeminal nerve. However, these clinical outcome were evaluated. plan to further analyze the image of changes of DTI parameters did not correlate with intraoperative more patients to see if pre-treatment Methods rhizotomy needle position or image can help us select patients Thirty-three patients with trigeminal recurrence of neuralgia. who are more responsive and neuralgia were recruited, and DTI was suitable for percutaneous performed before and two weeks after Conclusions radiofrequency rhizotomy. The cistern radiofrequency rhizotomy. segment of the trigeminal nerve was The differences in DTI following selected manually, the volume of the percutaneous radiofrequency References LEFT UPPER: Three-dimensional nerve, fractional anisotropy, apparent trigeminal rhizotomy showed the 1. Chen S, Yang J, Yeh M, Weng H, Chen C, Tsai reconstruction image from intraoperative Y. Using Diffusion Tensor Imaging to Evaluate diffusion coefficient, and axial, radial significant degree of trigeminal Microstructural Changes and Outcomes after CT fused with pre-treatment MRI which and mean diffusivities were measured. nerve change. However, it has no Radiofrequency Rhizotomy of Trigeminal Nerves showed the needle tip entering trigeminal During the operation, the distance in Patients with Trigeminal Neuralgia. PLOS cistern (Blue: needle, Green: trigeminal prognostic value in predicting clinical ONE. 2016;11(12):e0167584. between the rhizotomy needle and cistern, Yellow: bone, Purple: CSF). 2. Obermann M. Treatment options in trigeminal trigeminal cistern was measured by outcome with respect to pain relief neuralgia. Therapeutic Advances in Neurological RIGHT UPPER: Original intra-operative CT intraoperative CT and MRI fusion or recurrence. Further studies with Disorders. 2010;3(2):107-115. for navigation. Trigeminal cistern and CSF images. Numerical rating scale (NRS) serial DTI data over a longer period 3. Herweh C, Kress B, Rasche D, Tronnier V, were outlined according to image fusion was used to estimate the pain Troger J, Sartor K et al. Loss of anisotropy in with pre-treatment MRI. LOWER: are required to determine the true trigeminal neuralgia revealed by diffusion tensor intensity before and after operation. Radiofrequency rhizotomy needle clinical value of DTI changes. imaging. Neurology. 2007;68(10):776-778. Recurrence of neuralgia and 4. Fujiwara S, Sasaki M, Wada T, Kudo K, navigated by intra-operatvie CT. postoperative complications were also Hirooka R, Ishigaki D et al. High-resolution recorded for treatment outcome Diffusion Tensor Imaging for the Detection of Diffusion Abnormalities in the Trigeminal Nerves assessment. of Patients with Trigeminal Neuralgia Caused by Neurovascular Compression. Journal of Neuroimaging. 2011;21(2):e102-e108. 5. Lutz J, Linn J, Mehrkens J, Thon N, Stahl R, Seelos K et al. Trigeminal Neuralgia due to Neurovascular Compression: High-Spatial- Resolution Diffusion-Tensor Imaging Reveals Microstructural Neural Changes. Radiology. 2011;258(2):524-530.