The Thalamus in Trigeminal Neuralgia: Structural and Metabolic Abnormalities, and Influence on Surgical Response

Overview

Journal BMC Neurol

Publisher Biomed Central

Specialty Neurology

Date 2021 Jul 25

PMID 34303364

Citations 9

Authors

Hayden Danyluk

Jennifer Andrews

Rohit Kesarwani

Peter Seres

Robert Broad

B Matt Wheatley

Tejas Sankar

Affiliations

Soon will be listed here.

Abstract

Background: Medically-refractory trigeminal neuralgia (TN) can be treated successfully with operative intervention, but a significant proportion of patients are non-responders despite undergoing technically successful surgery. The thalamus is a key component of the trigeminal sensory pathway involved in transmitting facial pain, but the role of the thalamus in TN, and its influence on durability of pain relief after TN surgery, are relatively understudied. We aimed to test the hypothesis that variations in thalamic structure and metabolism are related to surgical non-response in TN.

Methods: We performed a longitudinal, peri-operative neuroimaging study of the thalamus in medically-refractory TN patients undergoing microvascular decompression or percutaneous balloon compression rhizotomy. Patients underwent structural MRI and MR spectroscopy scans pre-operatively and at 1-week following surgery, and were classified as responders or non-responders based on 1-year post-operative pain outcome. Thalamus volume, shape, and metabolite concentration (choline/creatine [Cho/Cr] and N-acetylaspartate/creatine [NAA/Cr]) were evaluated at baseline and 1-week, and compared between responders, non-responders, and healthy controls.

Results: Twenty healthy controls and 23 patients with medically-refractory TN treated surgically (17 responders, 6 non-responders) were included. Pre-operatively, TN patients as a group showed significantly larger thalamus volume contralateral to the side of facial pain. However, vertex-wise shape analysis showed significant contralateral thalamus volume reduction in non-responders compared to responders in an axially-oriented band spanning the outer thalamic circumference (peak p = 0.019). Further, while pre-operative thalamic metabolite concentrations did not differ between responders and non-responders, as early as 1-week after surgery, long-term non-responders showed a distinct decrease in contralateral thalamic Cho/Cr and NAA/Cr, irrespective of surgery type, which was not observed in responders.

Conclusions: Atrophy of the contralateral thalamus is a consistent feature across patients with medically-refractory TN. Regional alterations in preoperative thalamic structure, and very early post-operative metabolic changes in the thalamus, both appear to influence the durability of pain relief after TN surgery.

Citing Articles

Pathophysiology and Management of Refractory Trigeminal Neuralgia.

Stern J, Ali R, Chiang C, Robertson C Curr Neurol Neurosci Rep. 2024; 25(1):10.

PMID: 39665844 DOI: 10.1007/s11910-024-01387-2.

Thalamic changes in patients with chronic facial pain.

Pashkov A, Filimonova E, Zaitsev B, Martirosyan A, Moysak G, Rzaev J Neuroradiology. 2024; .

PMID: 39644395 DOI: 10.1007/s00234-024-03508-7.

Exploring the Thalamus as a Target for Neuropathic Pain Management: An Integrative Review.

Pires M, McBenedict B, Ahmed I, Yau R, Fong Y, Goh K Cureus. 2024; 16(5):e60130.

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Clinical and cognitive effects of external trigeminal nerve stimulation (eTNS) in neurological and psychiatric disorders: a systematic review and meta-analysis.

Westwood S, Conti A, Tang W, Xue S, Cortese S, Rubia K Mol Psychiatry. 2023; 28(10):4025-4043.

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Thalamic neurometabolite alterations in chronic low back pain: a common phenomenon across musculoskeletal pain conditions?.

Weerasekera A, Knight P, Alshelh Z, Morrissey E, Kim M, Zhang Y Pain. 2023; 165(1):126-134.

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