Day: July 8, 2026

J Neurosurg 145:36–44, 2026

This clinical study evaluates hemodynamic parameters derived from computational fluid dynamics (CFD) to predict microvascular decompression (MVD) efficacy in patients with classic trigeminal neuralgia (CTN). Using preoperative MR angiography and CFD, the authors compared PSF, PSPD, maximum WSS, and OSI between effective and ineffective MVD cohorts and developed logistic models to forecast surgical outcomes.

Results show lower peak systolic flow (PSF) and higher PSPD, maximum WSS, and OSI in effective cases; PSF and maximum WSS emerged as independent predictors. The best predictive model achieved AUC 0.920 with 90% sensitivity and specificity, supporting integration of hemodynamic metrics into preoperative decision-making for personalized CTN treatment.

Objective Evaluate whether CFD-derived hemodynamic parameters can predict microvascular decompression (MVD) efficacy in classic trigeminal neuralgia (CTN).

Design/participants 56 unilateral CTN patients (May 2022–Dec 2023) split into 28 effective vs 28 ineffective MVD outcomes; effectiveness defined as VAS pain score dropping to 0 on postoperative day 1, while ineffectiveness meant pain persisted (>0) through 3 months.

Workflow Use preoperative time-of-flight MR angiography to identify the neurovascular compression (NVC) zone, reconstruct the offending vessel segment, and run CFD to quantify PSF, PSPD, WSS, and OSI.

Key group differences Effective MVD associated with lower PSF (0.202 vs 0.306 ml/sec) and higher PSPD, maximum WSS, and OSI in the NVC zone (all statistically significant).

Independent predictors PSF and maximum WSS remained significant predictors of MVD efficacy in multivariable logistic regression.

Prediction performance A backward-selection logistic model achieved AUC 0.920 with 90% sensitivity and 90% specificity for predicting MVD efficacy.

Clinical interpretation Hemodynamic patterns consistent with higher vascular resistance/adverse shear environment at effective NVC sites, supporting use of CFD metrics to distinguish effective vs ineffective NVC.

Implication Integrating hemodynamic parameters (especially PSF and maximum WSS) could guide personalized treatment selection and improve preoperative prediction of MVD benefit.