CSF neuron-specific enolase as a biomarker of neurovascular conflict severity in drug-resistant trigeminal neuralgia: a prospective study in patients submitted to microvascular decompression

Background Although neurovascular conflict (NVC) is the most widely accepted cause of trigeminal neuralgia (TN), few articles have analyzed molecular and biochemical mechanisms underlying TN. In the present study, we dosed neuron-specific enolase (NSE) on serum and CSF samples of 20 patients submitted to microvascular decompression (MVD) and correlated these findings with the type of NVC. Methods Blood samples were obtained preoperatively and 48 h after MVD. CSF from trigeminal cistern was intraoperatively obtained. NSE levels were measured using the Diasorin kit (LIAISON (R) NSE). NVC was classified as contact or trigeminal nerve distortion/indentation or trigeminal root atrophy based on MRI and intraoperative findings. Clinical outcome was measured by acute pain relief (APR) and Barrow Neurological Institute (BNI) scale at last available follow-up (FU; 6.40 & PLUSMN; 5.38 months). Results APR was obtained in all patients. A statistically significant BNI reduction was obtained at latest FU (p < 0.0001). Serum NSE levels significantly decreased following MVD (from 12.15 +/- 3.02 ng/mL to 8.95 +/- 2.83 ng/mL, p = 0.001). The mean CSF NSE value was 48.94 ng/mL, and the mean CSF/serum NSE rate was 4.18 with a strong correlation between these two variables (p = 0.0008). CSF NSE level in trigeminal root atrophy group was significantly higher compared to contact (p = 0.0045) and distortion/indentation (p = 0.010) groups. Conclusion NSE levels seem to be related to the etiopathology and severity of NVC. A significant reduction of serum NSE levels could be related to the resolution of the NVC and clinical TN improvement.

Automated summary

This study measured the levels of neuron-specific enolase (NSE) in the serum and cerebrospinal fluid (CSF) of 20 patients undergoing microvascular decompression (MVD) and correlated these findings with the type of neurovascular conflict (NVC). Results showed that NSE levels were related to the etiopathology and severity of NVC. A significant reduction in serum NSE levels was associated with the resolution of NVC and clinical improvement in trigeminal neuralgia (TN).