Trigeminal Neuralgia due to Neurovascular Compression: High-Spatial-Resolution Diffusion-Tensor Imaging Reveals Microstructural Neural Changes

Radiology ◽  
2011 ◽  
Vol 258 (2) ◽  
pp. 524-530 ◽  
Author(s):  
Juergen Lutz ◽  
Jennifer Linn ◽  
Jan H. Mehrkens ◽  
Niklas Thon ◽  
Robert Stahl ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Trigeminal Neuralgia ◽  
Spatial Resolution ◽  
High Spatial Resolution ◽  
Diffusion Tensor ◽  
Neurovascular Compression

Diffusivity parameters of diffusion tensor imaging and apparent diffusion coefficient as imaging markers for predicting the treatment response of patients with trigeminal neuralgia

2020 ◽  
Vol 132 (6) ◽  
pp. 1993-1999 ◽  
Author(s):  
Yu-Li Lee ◽  
Shu-Tian Chen ◽  
Jen-Tsung Yang ◽  
Hsu-Huei Weng ◽  
Hsueh-Lin Wang ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
Diffusion Tensor Imaging ◽  
Trigeminal Neuralgia ◽  
Apparent Diffusion Coefficient ◽  
Treatment Response ◽  
Diffusion Tensor ◽  
Imaging Biomarkers ◽  
Neurovascular Compression ◽  
Apparent Diffusion ◽  
Trigeminal Nerves

OBJECTIVETrigeminal neuralgia (TN) is facial pain that is usually caused by neurovascular compression syndrome and is characterized by suddenly intense and paroxysmal pain. Radiofrequency lesioning (RFL) is one of the major treatments for TN, but the treatment response for RFL is sometimes inconsistent, and the recurrence of TN is not uncommon. This study aimed to estimate the outcome predictors of TN treated with RFL by using the parameters of diffusion tensor imaging (DTI).METHODSFifty-one patients with TN who were treated with RFL were enrolled in the study. MRI was performed in all patients within 1 week before surgery. The visual analog scale was used to evaluate symptom severity at three time points: before, 1 week after, and 3 months after RFL. The involved cisternal segment of the trigeminal nerves was manually selected, and the histograms of each of the diffusivity metrics—including the apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD)—were measured. The differences in the means, as well as the kurtosis and skewness of each of the diffusivity metrics between the nonrecurrent and recurrent groups, were then analyzed using the Mann-Whitney U-test.RESULTSThere were significantly lower kurtosis values (a broader peak of the distributional curves) for both FA and ADC in the recurrent group (p = 0.0004 and 0.015, respectively), compared to the nonrecurrent group. The kurtoses of AD and RD, as well as the mean and skewness of all other diffusivity metrics, did not show significant differences between the two groups.CONCLUSIONSThe pretreatment diffusivity metrics of DTI and ADC may be feasible imaging biomarkers for predicting the outcome of TN after RFL. A clarification of the kurtosis value of FA and ADC is helpful for determining the prognosis of patients after RFL.

scholarly journals First application of 7-T ultra–high field diffusion tensor imaging to detect altered microstructure of thalamic-somatosensory anatomy in trigeminal neuralgia

2020 ◽  
Vol 133 (3) ◽  
pp. 839-847 ◽  
Author(s):  
John W. Rutland ◽  
Kuang-Han Huang ◽  
Corey M. Gill ◽  
Dillan F. Villavisanis ◽  
Judy Alper ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Trigeminal Neuralgia ◽  
Fractional Anisotropy ◽  
High Field ◽  
Diffusion Tensor ◽  
Mean Diffusivity ◽  
Neurovascular Compression ◽  
Healthy Controls ◽  
Ultra High Field ◽  
Field Diffusion

OBJECTIVETrigeminal neuralgia (TN) is a debilitating neurological disease that commonly results from neurovascular compression of the trigeminal nerve (CN V). Although the CN V has been extensively studied at the site of neurovascular compression, many pathophysiological factors remain obscure. For example, thalamic-somatosensory function is thought to be altered in TN, but the abnormalities are inadequately characterized. Furthermore, there are few studies using 7-T MRI to examine patients with TN. The purpose of the present study was to use 7-T MRI to assess microstructural alteration in the thalamic-somatosensory tracts of patients with TN by using ultra–high field MRI.METHODSTen patients with TN and 10 age- and sex-matched healthy controls underwent scanning using 7-T MRI with diffusion tensor imaging. Structural images were segmented with an automated algorithm to obtain thalamus and primary somatosensory cortex (S1). Probabilistic tractography was performed between the thalamus and S1, and the microstructure of the thalamic-somatosensory tracts was compared between patients with TN and controls.RESULTSFractional anisotropy of the thalamic-somatosensory tract ipsilateral to the site of neurovascular compression was reduced in patients (mean 0.43) compared with side-matched controls (mean 0.47, p = 0.01). The mean diffusivity was increased ipsilaterally in patients (mean 6.58 × 10−4 mm2/second) compared with controls (mean 6.15 × 10−4 mm2/second, p = 0.02). Radial diffusivity was increased ipsilaterally in patients (mean 4.91 × 10−4 mm2/second) compared with controls (mean 4.44 × 10−4 mm2/second, p = 0.01). Topographical analysis revealed fractional anisotropy reduction and diffusivity elevation along the entire anatomical S1 arc in patients with TN.CONCLUSIONSThe present study is the first to examine microstructural properties of the thalamic-somatosensory anatomy in patients with TN and to evaluate quantitative differences compared with healthy controls. The finding of reduced integrity of these white matter fibers provides evidence of microstructural alteration at the level of the thalamus and S1, and furthers the understanding of TN neurobiology.

177 Microstructural Neural Changes Due to Neurovascular Compression in Trigeminal Neuralgia Detcted by Diffusion Tensor Imaging (DTI

Neurosurgery ◽  
2013 ◽  
Vol 60 ◽  
pp. 178-179
Author(s):  
Jan H. Mehrkens ◽  
Niklas Thon ◽  
Jennifer Linn ◽  
Hartmut Brückmann ◽  
Joerg-Christian Tonn ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Trigeminal Neuralgia ◽  
Diffusion Tensor ◽  
Neurovascular Compression ◽  
Diffusion Tensor Imaging Dti

scholarly journals Microstructural alterations in trigeminal neuralgia determined by diffusion tensor imaging are independent of symptom duration, severity, and type of neurovascular conflict

2016 ◽  
Vol 124 (3) ◽  
pp. 823-830 ◽  
Author(s):  
Juergen Lutz ◽  
Niklas Thon ◽  
Robert Stahl ◽  
Nina Lummel ◽  
Joerg-Christian Tonn ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Trigeminal Neuralgia ◽  
Diffusion Tensor ◽  
Contralateral Side ◽  
Symptom Duration ◽  
Neurovascular Compression ◽  
Neurovascular Conflict ◽  
Duration Of Symptoms ◽  
Structural Alterations ◽  
Apparent Diffusion Coefficient Values

OBJECT In this prospective study diffusion tensor imaging (DTI) was used to evaluate the influence of clinical and anatomical parameters on structural alterations within the fifth cranial nerve in patients with trigeminal neuralgia (TN) due to neurovascular compression. METHODS Overall, 81 patients (40 men and 41 women; mean age 60 ± 5 years) with typical TN were included who underwent microsurgical decompression. Preoperative 3.0-T high-resolution MRI and DTI were analyzed in a blinded fashion. The respective fractional anisotropy (FA) and apparent diffusion coefficient values were compared with the clinical, imaging, and intraoperative data. This study was approved by the institutional review board, and written informed consent was obtained from all patients. RESULTS DTI analyses revealed significantly lower FA values within the vulnerable zone of the affected trigeminal nerve compared with the contralateral side (p = 0.05). The DTI analyses also included 3 patients without clear evidence of neurovascular conflict on preoperative MRI. No differences were seen between arterial and venous compression. Lower FA values were found 5 months after symptom onset; however, no correlation was found with the duration of symptoms or severity of compression. CONCLUSIONS DTI analysis allows the quantification of structural alterations, even in those patients without any discernible neurovascular contact on MRI. Moreover, our findings support the hypothesis that both the arteries and veins can cause structural alterations that lead to TN. These aspects can be useful for making treatment decisions.

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