Individualized rs-fMRI reveals brain-circuit heterogeneity and predicts early recurrence in trigeminal neuralgia

Objective To identify abnormal brain regions in patients with trigeminal neuralgia (TN) and screen for specific regions that can predict short-term recurrence after percutaneous radiofrequency ablation (RFT). Methods Resting-state functional magnetic resonance imaging (rs-fMRI) was used to identify differential brain regions in TN patients. An individualized rs-fMRI approach was applied to screen for recurrence-related brain regions in patients undergoing RFT. Among these, regions with a 100% recurrence rate were classified as high-risk recurrence regions. Treatment outcomes and changes in these differential brain regions were observed postoperatively. Results Thirty TN patients exhibited 19 differential brain regions. Four of these—RolandicOperL, Cerebellum₉L, LingualR, and CalcarineL—were newly identified as abnormal regions in TN. Among the 15 patients who underwent RFT, 15 potential recurrence-related regions were found. Six of these—contralateral InsulaL, FusiformL, Vermis₃, and TemporalSupL; ipsilateral Cerebellum₃R; and ipsilateral FusiformR (when involving V1 division pain) —were identified as high-risk recurrence regions. Follow-up scans confirmed that these recurrence-related differential brain regions were either eliminated or attenuated after surgery. Conclusion Patients with trigeminal neuralgia exhibit abnormalities in multiple brain regions. These findings demonstrate that individualized functional imaging biomarkers provide an effective framework for stratifying the risk of early postoperative recurrence. Specifically, abnormalities in the InsulaL, FusiformL, Cerebellum₃R, TemporalSupL, Vermis₃, and FusiformR can be defined as high-risk brain regions for predicting short-term recurrence after radiofrequency ablation.