What question did this study set out to answer?

This study aims to explore the relationship between STN lesions and TZAN, as well as factors influencing diagnostic accuracy and treatment outcomes.

April 14, 2026

Spinal trigeminal nucleus lesions in trigeminal zoster-associated neuralgia: A retrospective cohort study on diagnostic value and prognostic factors

Key Points

This study aims to explore the relationship between STN lesions and TZAN, as well as factors influencing diagnostic accuracy and treatment outcomes.
Conducted a retrospective cohort study involving 105 TZAN patients, matched with non-TZAN controls and classical trigeminal neuralgia patients.
Used MRI to evaluate STN lesions, with assessments performed by blinded radiologists.
Collected clinical data, including pain ratings and medication dosages, through medical records and follow-up calls.
Applied multivariate logistic regression to identify factors related to STN hyperintensity and TZAN treatment efficacy.
STN lesion detection was significantly higher in TZAN (62.9%) compared to non-TZAN controls (1.0%) and classical trigeminal neuralgia (68.9%).
Sensitivity, specificity, and accuracy for TZAN diagnosis were found to be 62.9%, 99.0%, and 81.0%, respectively.
Age and being in the subacute phase of TZAN were strong predictors of STN hyperintensity.
Patients without STN lesions showed improved short-term pain relief compared to those with lesions, though long-term outcomes were similar.
Chronic phase TZAN predicted poorer prognosis compared to acute and subacute stages.

Abstract

Background Trigeminal zoster-associated neuralgia (TZAN) is a refractory intractable craniofacial neuropathic pain with a high risk of progressing to postherpetic neuralgia. Abnormal T2-weighted magnetic resonance imaging (MRI) hyperintensity in the spinal trigeminal nucleus (STN) has been reported in TZAN patients, but its diagnostic value, influencing factors and association with prognosis remain insufficiently explored. This study aimed to investigate the correlation between STN lesions and TZAN and identify factors affecting STN signal characteristics and TZAN therapeutic efficacy. Methods This retrospective cohort study included 105 TZAN patients, 105 non-TZAN normal controls (NC) and 287 classical trigeminal neuralgia (CTN) patients who underwent cranial MRI at Shandong Provincial Hospital Affiliated to Shandong First Medical University between September 2018 and March 2024. Propensity score matching (1:1, caliper = 0.1) was used to balance baseline differences between the TZAN and CTN groups. STN lesions were evaluated in a blinded manner by two radiologists, and clinical data (pain Numeric Rating Scale scores, pregabalin dosage) were collected via medical records and 6-month telephone follow-up. Multivariate logistic regression analyzed factors associated with STN hyperintensity and TZAN efficacy (pain relief ≥ 80% defined as “excellent response”). Results STN lesion detection rate was significantly higher in TZAN than in NC (62.9% vs. 1.0%, p 0.05). Chronic phase predicted poor prognosis (vs. acute: OR = 6.55, p = 0.005; vs. subacute: OR = 5.39, p = 0.017). Conclusions STN lesions are highly specific for TZAN and may serve as an auxiliary diagnostic indicator. STN hyperintensity is most prominent in elderly TZAN patients in the subacute phase, potentially acting as a subacute-phase imaging marker. Early intervention in subacute TZAN may be critical for improving prognosis.

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Cite This Study

Wang et al. (Wed,) studied this question.

synapsesocial.com/papers/69ddda22e195c95cdefd7a85 https://doi.org/https://doi.org/10.1177/03331024261435927

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