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Relationship Between the Curative Effects of Carbamazepine Administration and the Neurovascular Compression Volume of the Trigeminal Nerve Measured Using Magnetic Resonance Cisternography

Tanaka, Tatsurou DDS, PhD*; Sakamoto, Eiji DDS, PhD; Shiiba, Shunji DDS, PhD; Oda, Masafumi DDS*; Kito, Shinji DDS, PhD*; Wakasugi-Sato, Nao DDS, PhD*; Matsumoto-Takeda, Shinobu DDS, PhD*; Imamura, Yoshiki DDS, PhD§; Nakanishi, Osamu DDS, PhD; Morimoto, Yasuhiro DDS, PhD*

doi: 10.1097/AJP.0b013e3181ada29c
Original Articles
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Objectives To elucidate the relationship between the extent of pain and neurovascular compression (NVC) volume, measured by magnetic resonance (MR) cisternography, in patients with trigeminal neuralgia. In addition, we aimed to evaluate the relationship between NVC volume and the efficacy of carbamazepine administration in patients with trigeminal neuralgia.

Methods MR cisternography was performed on 214 patients with clinical signs and symptoms that suggested trigeminal neuralgia retrospectively. The extent of their pain was evaluated using visual analog scales. Next, only carbamazepine was administered as the initial treatment. For the patients with NVC detectable on MR cisternography, the relationship between the extent or nature of the pain and the neurovascular volume was analyzed. In addition, the correlation between the efficacy of carbamazepine treatment and the NVC volume was evaluated retrospectively.

Results Of the 214 patients evaluated, 144 were deemed to have NVC. In these 144 patients, a significant difference was found between the NVC volume and the curative effects of 100 mg/d carbamazepine. However, no significant correlation was found between the extents of pain by visual analog score or between the daily dosage of carbamazepine and the NVC volume measured by MR cisternography.

Conclusions Three-dimensional MR cisternography is very useful for detecting the site of NVC in patients with trigeminal neuralgia. NVC measured by this technique may indicate the prognosis after initial treatment. The present results suggest that the evaluation of NVC volume by MR cisternography would be useful in choosing the initial treatment for patients with trigeminal neuralgia.

*Department of Oral Diagnostic Science

Department of Anesthesia, Kyushu Dental College, Kokurakita-ku, Kitakyushu

Department of Anesthesiology, National Defense Medical College, Tokorozawa, Saitama

§Department of Oral Diagnosis, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan

Supported in part by grants from the Grant-in-Aid for Scientific Research from the Ministry of Education, Science, Sports, and Culture of Japan, a grant-in-aid for scientific research from the alumni association of Kyushu Dental College, and a grant-in-aid for scientific research from the president of Kyushu Dental College to YM and TT.

Reprints: Yasuhiro Morimoto, DDS PhD, Department of Oral Diagnostic Science, Kyushu Dental College, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu 803-8580, Japan (e-mail: rad-mori@kyu-dent.ac.jp).

Received for publication December 16, 2008; revised May 1, 2009; accepted May 6, 2009

© 2009 Lippincott Williams & Wilkins, Inc.