Reciprocal association between neurovascular conflict and trigeminal neuralgia: a systematic review and meta-analysis

Background: Classical trigeminal neuralgia is thought to be primarily caused by neurovascular contact of the trigeminal nerve root. However, neurovascular contact is also seen in individuals without trigeminal neuralgia on magnetic resonance imaging (MRI). Understanding this reciprocal association is important for clinical decision-making, as microvascular decompression is usually considered in medication-refractory cases. Methods: We performed a systematic review and meta-analysis of MRI studies evaluating neurovascular contact in patients with trigeminal neuralgia and in individuals without trigeminal neuralgia. PubMed, ScienceDirect, and the Cochrane Library were searched for studies published between 2015 and 2025. Seven studies involving 699 patients and 1092 trigeminal nerves (357 symptomatic and 735 asymptomatic) met the inclusion criteria and were analyzed. Results: Neurovascular contact was present in 66.7% of nerves in individuals without trigeminal neuralgia (95% confidence interval: 58.9–73.8%) and in 87.5% of nerves in patients with trigeminal neuralgia (95% CI: 81.3–91.8%). The symptomatic side showed neurovascular contact at significantly higher rates than asymptomatic nerves. Severe contact was rarely observed in non-trigeminal neuralgia patients, but was strongly associated with symptomatic nerves. Neurovascular contact at the root entry zone was not significantly linked to the symptomatic side. Interpretation across studies was limited by heterogeneous and non-standardized reporting of neurovascular contact location and severity. Conclusions: Simple neurovascular contact is common in individuals without trigeminal neuralgia, whereas severe contact is more specific to symptomatic nerves, supporting a reciprocal association between neurovascular conflict and trigeminal neuralgia. Neurovascular contact should not be regarded as a binary MRI finding; severity, location, and vessel type appear to be important for symptom development. Standardized MRI reporting protocols and larger, well-designed studies are needed to refine diagnostic criteria and imaging-based assessment of trigeminal neuralgia. The PROSPERO Registration: CRD420250611313.

Trigeminal neuralgia; Neurovascular conflict; Trigeminal nerve; Magnetic resonance imaging

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