Posted on 19-12-2018

Diffusion tensor imaging as a clinically translatable prognostication tool for neurosurgery

Outcomes of neurosurgical treatments for chronic pain are typically evaluated using clinical diagnostic measures. These measures, while important, are limited because they do not provide objective information about treatment effects nor offer any prognostic value. Advanced modalities of imaging may be used as a tool to monitor the effects of treatment and predict whether patients will achieve long-term pain relief.

Lead author and UTCSP member Sarasa Tohyama, together with senior author Dr. Mojgan Hodaie and colleagues, assessed the utility of an advanced neuroimaging technique – diffusion tensor imaging (used to measure brain white matter) – in predicting whether patients that have undergone radiosurgical treatment for pain will achieve long-lasting clinical benefit. Specifically, they examined patients with trigeminal neuralgia, a severe chronic neuropathic facial pain condition. The radiosurgical treatment, called Gamma Knife radiosurgery, involves delivering a high dose of radiation to the trigeminal nerve of these patients. They found that diffusion tensor imaging can measure the effects of radiation on the nerve, a capability that conventional imaging techniques do not offer. Furthermore, these measures when taken at an early postsurgical timepoint, can determine the likelihood of whether patients will achieve sustained pain relief. Specifically, if there are sufficient white matter changes at the surgical target, patients are likely to be long-term responders. Thus, diffusion tensor imaging may serve as an important adjunct to current clinical diagnostic measures, as it allows physicians to have additional information to rely upon for the postoperative assessment of pain. This may allow decisions about repeat or alternative interventions to be made sooner for patients and improve the management of their pain.


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Reference: Tohyama S, Hung PSP, Zhong J, Hodaie M. (2018). Early postsurgical diffusivity metrics for prognostication of long-term pain relief after Gamma Knife radiosurgery for trigeminal neuralgia. Journal of Neurosurgery.