20. Magnetic resonance volumetry confirms trigeminal nerve atrophy in patients suffering from essential trigeminal neuralgia

2014 ◽  
Vol 125 (5) ◽  
pp. e31
Author(s):  
J. Keller ◽  
V. Švehlík ◽  
A. Rulseh ◽  
D. Urgošík
Keyword(s):  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Magnetic Resonance Volumetry

TRIGEMINAL NEURALGIA AND VASCULAR COMPRESSION IN PATIENTS WITH TRIGEMINAL SCHWANNOMAS

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. E974-E975 ◽  
Author(s):  
Jonathan P. Miller ◽  
Feridun Acar ◽  
Kim J. Burchiel
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Gamma Knife Radiosurgery ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Intracranial Tumors ◽  
Resonance Imaging

Abstract OBJECTIVE Trigeminal neuralgia (TN) is often associated with neurovascular compression. However, intracranial tumors are occasionally observed, particularly when symptoms are atypical. We describe three patients with Type-1 TN and trigeminal schwannoma diagnosed by magnetic resonance imaging, with concomitant arterial compression of the trigeminal nerve. CLINICAL PRESENTATION All three patients had Type-1 TN with spontaneous onset, paroxysm-triggered pain, and response to antiepileptic medication. Contrast-enhanced T1-weighted magnetic resonance imaging scans demonstrated an ipsilateral enhancing perineural mass consistent with a schwannoma. Two of the three patients had previously undergone gamma knife radiosurgery without improvement. Subsequent high-resolution magnetic resonance imaging in all three patients revealed obvious compression of the trigeminal nerve by an arterial structure. INTERVENTION Two patients underwent retrosigmoid craniectomy followed by microvascular decompression and remain pain-free. One patient elected not to pursue surgical intervention. CONCLUSION Although intracranial tumors are occasionally observed in patients with TN, neurovascular compression must still be considered as an etiology, especially if typical TN symptoms are reported.

Trigeminal Nerve Asymmetry in Classic Trigeminal Neuralgia –  Evaluation by Magnetic Resonance Imaging

2014 ◽  
Vol 77/110 (5) ◽  
pp. 582-585 ◽  
Author(s):  
Dušan Urgošík ◽  
Aaron Michael Rulseh ◽  
Jiří Keller ◽  
Vojtěch Švehlik ◽  
Jagan Mohan Venkatram Narasimha Pingle ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Resonance Imaging

Three-dimensional Fast Imaging Employing Steady-state Acquisition Magnetic Resonance Imaging for Stereotactic Radiosurgery of Trigeminal Neuralgia

Neurosurgery ◽  
2005 ◽  
Vol 56 (3) ◽  
pp. E628-E628 ◽  
Author(s):  
Gabriela-del-Rocío Chávez Chávez ◽  
Antonio A.F. De Salles ◽  
Timothy D. Solberg ◽  
Alessandra Pedroso ◽  
Dulce Espinoza ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Steady State ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Stereotactic Radiosurgery ◽  
Trigeminal Nerve ◽  
Three Dimensional ◽  
Fast Imaging ◽  
Resonance Imaging ◽  
Entry Zone

Abstract OBJECTIVE: The aim of this study was to demonstrate the use and applications of the three-dimensional fast imaging employing steady-state acquisition (3-D-FIESTA) magnetic resonance imaging sequence in targeting and planning for stereotactic radiosurgery of trigeminal neuralgia. METHODS: A 3-D-FIESTA sequence for visualization of cranial nerves in the cranial base was added to the routine magnetic resonance imaging scan to enhance the treatment planning for trigeminal neuralgia. T1-weighted images, 1 mm thick, were directly compared with the FIESTA sequence for the exact visualization of the trigeminal entry zone and surrounding vasculature. The target accuracy was evaluated by image fusion of computed tomographic and magnetic resonance imaging scans. The anatomy visualized with the FIESTA sequence was validated by direct inspection of the gross anatomic specimens of the trigeminal complex. RESULTS: A total of 15 consecutive patients, 10 women and 5 men, underwent radiosurgery for essential trigeminal neuralgia between April and July, 2003. The mean age of the patients was 65.2 years (range, 24–83 yr). Nine patients had right-sided symptoms. Four patients had had previous surgery (two microvascular decompression, one percutaneous rhizotomy, and one radiofrequency thermocoagulation). The 3-D-FIESTA sequence successfully demonstrated the trigeminal complex (root entry zone, trigeminal ganglion, rootlets, and vasculature) in 14 patients (93.33%). The 3-D-FIESTA sequence also allowed visualization of the branches of the trigeminal nerve inside Meckel's cavity. This exact visualization correlated precisely with the anatomic specimens. In one patient (6.66%), it was not possible to demonstrate the related vasculature. However, the other structures were clearly visualized. CONCLUSION: The 3-D-FIESTA sequence is used in this study for demonstration of the exact anatomy of the trigeminal complex for the purpose of radiosurgical planning and treatment of trigeminal neuralgia. With such imaging techniques, radiosurgical targeting of specific trigeminal nerve branches may be feasible. It has not been possible previously to target individual branches of the trigeminal nerve.

scholarly journals Uncommon Cause of Trigeminal Neuralgia: Tentorial Ossification over Trigeminal Notch

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Sun Woo Bang ◽  
Kyung Ream Han ◽  
Seung Ho Kim ◽  
Won Ho Jeong ◽  
Eun Jin Kim ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Radiological Evaluation ◽  
Resonance Imaging ◽  
Tentorium Cerebelli ◽  
Magnetic Resonance Imaging Mri

Ossification of the tentorium cerebelli over the trigeminal notch is rare, but it may cause compression of the trigeminal nerve, leading to trigeminal neuralgia (TN). We were unable to find any previously reported cases with radiological evaluation, although we did find one case with surgically proven ossification of the tentorium cerebelli. Here, we present a case of TN caused by tentorial ossification over the trigeminal notch depicted on magnetic resonance imaging (MRI) and computed tomography (CT).

Trigeminal Nerve-Blood Vessel Relationship as Revealed by High-resolution Magnetic Resonance Imaging and Its Effect on Pain Relief after Gamma Knife Radiosurgery for Trigeminal Neuralgia

Neurosurgery ◽  
2002 ◽  
Vol 50 (6) ◽  
pp. 1261-1267 ◽  
Author(s):  
Ronald Brisman ◽  
Alexander G. Khandji ◽  
Robertus B.M. Mooij
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Pain Relief ◽  
Blood Vessel ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Gamma Knife Radiosurgery ◽  
Resonance Imaging

Abstract OBJECTIVE Blood vessel (BV) compression of the trigeminal nerve (Cranial Nerve [CN] V) is a common cause of trigeminal neuralgia (TN). High-resolution magnetic resonance imaging scans obtained during gamma knife radiosurgery (GKRS) in patients with TN may be used to analyze the BV-CN V relationship. Follow-up data from a large series of patients treated with GKRS for TN were used to provide information regarding the BV-CN V relationship and pain relief. METHODS T1-weighted, axial 1-mm-thick volume acquisition magnetic resonance imaging scans were obtained through the area of CN V at its exit from the brainstem after injection of 15 ml of gadolinium. The BV-CN V relationship on the symptomatic side that was treated with GKRS was categorized into the following groups: Group 1 (no close relationship), Group 2 (BV close to CN V but not touching it), and Groups 3 and higher (BV-CN V contact). RESULTS A total of 181 symptomatic nerves were studied in 179 patients with TN who were treated with GKRS. In BV-CN V Groups 1, 2, and 3 and higher, respectively, were 43 sides (24%), 31 sides (17%), and 107 sides (59%). In 100 sides where there was no surgical procedure before GKRS, 50% or greater pain relief was more likely in those with BV-CN V contact (51 [88%] of 58 sides) than in those without BV-CN V (29 [69%] of 42 sides) (P = 0.024). BV-CN V contact was observed more often in men (55 [69%] of 80 sides) than in women (52 [52%] of 101 sides) (P = 0.023) and more often in patients who had unilateral TN (104 [62%] of 169 patients) rather than bilateral TN (2 [20%] of 10 patients) (P = 0.016). CONCLUSION In patients who have not undergone previous surgery for TN, BV-CN V contact revealed by high-resolution magnetic resonance imaging may indicate a particularly favorable response to GKRS.

Preoperative visualization of neurovascular anatomy in trigeminal neuralgia

2008 ◽  
Vol 108 (3) ◽  
pp. 477-482 ◽  
Author(s):  
Jonathan Miller ◽  
Feridun Acar ◽  
Bronwyn Hamilton ◽  
Kim Burchiel
Keyword(s):  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Surgical Approach ◽  
Mr Angiography ◽  
Neurovascular Compression ◽  
Surface Rendering ◽  
Contrast Enhanced ◽  
Vascular Structures ◽  
Neurovascular Anatomy

Object The authors report on a novel technique to identify neurovascular compression in trigeminal neuralgia (TN). Using 3D reconstructed high-resolution balanced fast-field echo (BFFE) images fused with 3D time-of-flight (TOF) magnetic resonance (MR) angiography and Gd-enhanced 3D spoiled gradient recalled sequence, it is possible to objectively visualize the trigeminal nerve and nearby arteries and veins. Methods Magnetic resonance imaging was performed in 18 patients with unilateral TN using 3 sequences: BFFE, 3D TOF angiography, and 3D Gd-enhanced imaging. The images were imported into OsiriX imaging software; after their fusion, a 3D false-color reconstruction was produced using surface rendering. The reconstructed images objectively differentiate nerves and vessels and can be viewed from any angle, including the anticipated surgical approach. Results Fifteen patients were predicted to have neurovascular compression on the symptomatic side (9 arterial and 6 venous compressions). All patients had a vascular structure that was identical in location and configuration to that predicted on preoperative analysis. The 3 patients without predicted compression underwent surgical exploration because they manifested the classic symptoms. As expected, exploration in 2 of these patients revealed no offending vessel. The third patient had a small vein embedded in the trigeminal nerve that was beyond the resolution of the 3D Gd-enhanced study. Conclusions Combining BFFE with MR angiography and Gd-enhanced MR images capitalizes on the advantages of both techniques, enabling MR angiography and contrast-enhanced MR imaging discrimination of vascular structures at BFFE resolution. This results in an unambiguous 3D image that can be used to identify the neurovascular compression and plan the surgical approach.

Trigeminal Neuralgia in a Patient with a Dural Arteriovenous Fistula in Meckel's Cave: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (1) ◽  
pp. 216-221 ◽  
Author(s):  
Rose Du ◽  
Devin K. Binder ◽  
Van Halbach ◽  
Nancy Fischbein ◽  
Nicholas M. Barbaro
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Arteriovenous Fistula ◽  
Trigeminal Nerve ◽  
Dural Arteriovenous Fistula ◽  
Gasserian Ganglion ◽  
Resonance Imaging ◽  
Meckel’S Cave ◽  
Meckel's Cave

Abstract OBJECTIVE AND IMPORTANCE Trigeminal neuralgia is often the result of vascular compression at the root entry zone of the trigeminal nerve. We report a case of trigeminal neuralgia in a patient with a dural arteriovenous fistula in Meckel's cave. Endovascular closure of the fistula resulted in elimination of the patient's pain at the gasserian ganglion level. CLINICAL PRESENTATION A 77-year-old woman was referred for treatment of trigeminal neuralgia after failed conservative treatment, including multiple gasserian ganglion blocks. Magnetic resonance imaging of the brain suggested a vascular lesion, and cerebral angiography demonstrated a dural arteriovenous fistula in Meckel's cave. INTERVENTION Endovascular coil embolization was performed, with obliteration of the dural arteriovenous fistula and resolution of facial pain but with decreased sensation in the face. CONCLUSION Trigeminal neuralgia may be associated with complex vascular lesions around the base of the brain and along the course of the trigeminal nerve. The evaluation of patients with trigeminal neuralgia should include high-quality, thin-section, magnetic resonance imaging scans, to exclude the possibility of vascular lesions and other structural lesions. In particular, patients who are being evaluated for surgical treatment of trigeminal neuralgia should undergo magnetic resonance imaging, with a focus on the course of the trigeminal nerve.

scholarly journals Refractory cluster-tic syndrome: The Hickam’s dictum

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Membrilla JA ◽  
◽  
Díaz de Terán J ◽  
Keyword(s):  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Cluster Headache ◽  
Medical Treatment ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Neurovascular Conflict ◽  
Surgical Exploration ◽  
Keywords Trigeminal Neuralgia ◽  
The Right

A 50-year-old man debuted with right trigeminal neuralgia. In the following years, it became refractory to medical treatment and ipsilateral cluster headache appeared. He was diagnosed with cluster-tic syndrome. A brain magnetic resonance with high-spatialresolution 3D T2 sequences (FIESTA) excluded the existence of neurovascular conflict, but a surgical exploration was indicated due to its torpid evolution. A venous contact with the right trigeminal nerve was confirmed in the surgery and microvascular decompression was performed. The patient’s evolution was favorable, improving the trigeminal neuralgia as well as the cluster headache. Keywords: Trigeminal neuralgia; cluster headache; cluster-tic syndrome; microvascular decompression.

Hippocampal and trigeminal nerve volume predict outcome of surgical treatment for trigeminal neuralgia

Cephalalgia ◽  
2019 ◽  
Vol 40 (6) ◽  
pp. 586-596
Author(s):  
Hayden Danyluk ◽  
Esther Kyungsu Lee ◽  
Scott Wong ◽  
Samiha Sajida ◽  
Robert Broad ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Characteristic Curve ◽  
Treatment Resistance ◽  
Structural Features ◽  
Magnetic Resonance Images ◽  
Receiver Operator Characteristic Curve ◽  
Hippocampus Volume

Background Many medically-refractory trigeminal neuralgia patients are non-responders to surgical treatment. Few studies have explored how trigeminal nerve characteristics relate to surgical outcome, and none have investigated the relationship between subcortical brain structure and treatment outcomes. Methods We retrospectively studied trigeminal neuralgia patients undergoing surgical treatment with microvascular decompression. Preoperative magnetic resonance imaging was used for manual tracing of trigeminal nerves and automated segmentation of hippocampus, amygdala, and thalamus. Nerve and subcortical structure volumes were compared between responders and non-responders and assessed for ability to predict postoperative pain outcome. Results In all, 359 trigeminal neuralgia patients treated surgically from 2005–2018 were identified. A total of 34 patients met the inclusion criteria (32 with classic and two with idiopathic trigeminal neuralgia). Across all patients, thalamus volume was reduced ipsilateral compared to contralateral to the side of pain. Between responders and non-responders, non-responders exhibited larger contralateral trigeminal nerve volume, and larger ipsilateral and contralateral hippocampus volume. Through receiver-operator characteristic curve analyses, contralateral hippocampus volume correctly classified treatment outcome in 82% of cases (91% sensitive, 78% specific, p = 0.008), and contralateral nerve volume correctly classified 81% of cases (91% sensitive, 75% specific, p < 0.001). Binomial logistic regression analysis showed that contralateral hippocampus and contralateral nerve volumes together classified outcome with 84% accuracy (Nagelkerke R2 = 65.1). Conclusion Preoperative hippocampal and trigeminal nerve volume, measured on standard clinical magnetic resonance images, may predict early non-response to surgical treatment for trigeminal neuralgia. Treatment resistance in medically refractory trigeminal neuralgia may depend on the structural features of both the trigeminal nerve and structures involved in limbic components of chronic pain.

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