Nomogram Model for Predicting the Risk of Recurrence after Surgery of the V3 Branch of the Trigeminal Nerve

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BACKGROUND: Factors influencing recurrence after V3 trigeminal nerve surgery remain unknown. OBJECTIVES: To analyze the risk factors affecting recurrence after trigeminal nerve branch V3 surgery, construct a nomogram prediction model, and verify the predictive efficacy of the model. STUDY DESIGN: A retrospective study. SETTING: This study was performed at the Affiliated Hospital of Jiaxing University, China. METHODS: Patients with mandibular nerve pain of the V3 branch of the trigeminal nerve treated with percutaneous puncture foramen ovale trigeminal mandibular nerve radiofrequency or trigeminal semilunar nerve microballoon compression at the Pain Department of the Affiliated Hospital of Jiaxing College, between January 2016 and April 2021, were enrolled and randomly divided into the training group (n = 108) and the test group (n = 47) according to the ratio of 7:3. The feasibility of the nomogram prediction model was further explored using multifactor logistic regression analysis based on the screening of independent predictors by the least absolute shrinkage and selection operator (LASSO) regression analysis using recurrence in one year after surgery as the outcome variable, and was assessed by the validation group. Finally, the discriminatory power, accuracy, and clinical utility of the prediction model were assessed using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA), respectively. RESULTS: Among the 155 patients with trigeminal V3 pain, 128 had no recurrence and 27 had recurrence one year after surgery. LASSO regression combined with multifactorial logistic regression analysis showed that age, procedure, and duration were factors influencing recurrence one year after surgery (P < 0.05). A nomogram prediction model was developed using the above variables. The AUC of the nomogram prediction model was 0.749 (95% CI [0.618, 0.879]) in the training group and 0.793 (95% CI [0.584, 0.980]) in the test group for postoperative recurrence of V3. The DCA showed that the net benefit of using the nomogram prediction model to predict the risk of postoperative recurrence of the V3 branch of the trigeminal nerve was higher when patients had a threshold probability of 0 to 0.486. LIMITATIONS: This was a single-center study. CONCLUSIONS: This study successfully developed and validated a highly accurate nomogram prediction model (with age, procedure, and duration as predictive variables), which can improve the early identification and screening of patients at high risk of recurrence after trigeminal nerve V3 branch surgery. KEY WORDS: Trigeminal neuralgia, mandibular nerve, risk factors, prediction model