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.

Preoperative Evaluation of Neurovascular Compression in Patients with Trigeminal Neuralgia by Use of Three-dimensional Reconstruction from Two Types of High-resolution Magnetic Resonance Imaging

Neurosurgery ◽  
2002 ◽  
Vol 51 (4) ◽  
pp. 956-962 ◽  
Author(s):  
Hideaki Akimoto ◽  
Tsukasa Nagaoka ◽  
Tadashi Nariai ◽  
Yoshiaki Takada ◽  
Kikuo Ohno ◽  
...  
Keyword(s):  
Steady State ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Preoperative Evaluation ◽  
Three Dimensional ◽  
Spatial Relationship ◽  
Magnetic Resonance Images ◽  
Neurovascular Compression

Abstract OBJECTIVE To assess the value of three-dimensional (3-D) images reconstructed from 3-D constructive interference in steady state (3-D-CISS) and 3-D fast inflow with steady-state precession (3-D-FISP) images for the visualization of neurovascular compression in patients with trigeminal neuralgia. METHODS Twenty-four consecutive patients with trigeminal neuralgia underwent preoperative 3-D-FISP and 3-D-CISS imaging. 3-D reconstruction of nerves and vessels was performed with the use of a volume-rendering method. We compared the 3-D reconstructed images with intraoperative findings. RESULTS 3-D-CISS and 3-D-FISP images scanned from the same position clearly delineated the trigeminal nerve and vessels. 3-D reconstructed images showed the spatial relationship between the trigeminal nerve and causative vessels. The responsible arteries were identified from the 3-D reconstructed images, which closely simulated the microscopic operative view. CONCLUSION 3-D reconstructions from two types of high-resolution magnetic resonance images (3-D-CISS and 3-D-FISP) are very useful for creating preoperative simulations and in deciding whether to perform surgery in patients with trigeminal neuralgia.

scholarly journals Semi-automatic method for analysing vocal tract morphology from real-time magnetic resonance images

2021 ◽  
Author(s):  
Michel Belyk ◽  
Christopher Carignan ◽  
Carolyn McGettigan
Keyword(s):  
Magnetic Resonance ◽  
Real Time ◽  
Vocal Tract ◽  
Structural Features ◽  
Magnetic Resonance Images ◽  
Training Data ◽  
Surrounding Tissue ◽  
User Input ◽  
Internal Structures ◽  
Automated Processing

Real-time magnetic resonance imaging is a technique that provides high contrast videographic data of the vocal tract that allow researchers to observe the internal structures that shape the sounds of speech. However, structural features need to be extracted from these vocal tract images to make them useful to researchers. We have developed a semi-automated processing pipeline that produces outlines of the vocal tract to quantify vocal tract morphology. Our approach uses simple tissue classification constrained to pixels that analysts have identified as likely to contain the vocal tract and surrounding tissue. This approach is supplemented with multiple opportunities for the analyst to intervene in order to ensure that outputs are robust to errors. Although this approach is more labour intensive than more fully automated alternatives, these costs are offset by the benefits of improving the quality of measurements. We demonstrate that this pipeline can be generalised to a range of datasets and that it remains reliable across analysts, particularly among analysts with vocal tract expertise. The pipeline’s reliance on user input presents a challenge to scalability if applied to very large. Measurements produced by this pipeline could be provide a broader scope of training data for fully automated methods in an effort to improve their generalisability.

Abstract T P32: Computer Aided Detection of Asymptomatic Cerebral Microbleeds on Magnetic Resonance Images

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Yan Li ◽  
Yining Huang ◽  
Jue Zhang ◽  
Jing Fang
Keyword(s):  
Magnetic Resonance ◽  
Rating Scale ◽  
Characteristic Curve ◽  
Magnetic Resonance Images ◽  
False Positives ◽  
Cerebral Microbleeds ◽  
Cad System ◽  
Automated Method ◽  
Skull Stripping ◽  
Computer Aided

Purpose: Manual rating of Cerebral microbleeds (CMBs) is time-consuming and inconsistent. Since the presence and number of CMBs have become a potential diagnostic and prognostic biomarker of stroke, an automatic identification method is required. We proposed a computer aided diagnosis (CAD) system for the detection of the CMBs on the magnetic resonance (MR) images automatically. Methods: Eighty-one patients were recruited in this study. CMBs on the MR T2* weighted images were manually rated according to the Microbleed Anatomic Rating Scale (MARS) criteria. Our automated method consisted of two steps: i) Pre-processing: After skull stripping, isolated islands of points were removed while holes were restored to avoid over segmentation. Local threshold segmentation was applied for the initial candidate selection. ii) Identification model: Seven features were extracted from each candidate: area, roundness, intensity, average of the boundary, contrast, shape-intensity and location-mark (according to the probability density templates calculated from the location information of the CMBs). For further identification of each candidate, Random Forest (RF) model was used to distinguish CMBs from the mimics. Results: A total of 337 CMBs in the 81 patients were studied. Comparing with the counting from the experienced doctors, high sensitivity of 92% (310/337) was achieved after pre-processing. The RF model eliminated most of the false-positives while maintaining a reliable sensitivity of 94% (291/310) and specificity of 96% (4272/4450). The area under the Receiver operating characteristic curve was 0.98 ± 0.02 for the detection model. In summary, this CAD system had an overall sensitivity of 86% (291/337) and specificity of 96% (4272/4450), producing only 2.2 false-positives per subject. Conclusion: This presented strategy is technically effective. The results indicate that it has the potential to be used for clinical detection of CMBs.

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.

Association between a black band on the inner membrane of a chronic subdural hematoma on T2*-weighted magnetic resonance images and enlargement of the hematoma

2003 ◽  
Vol 99 (5) ◽  
pp. 824-830 ◽  
Author(s):  
Toshio Imaizumi ◽  
Yoshifumi Horita ◽  
Toshimi Honma ◽  
Jun Niwa
Keyword(s):  
Surgical Treatment ◽  
Magnetic Resonance ◽  
Chronic Subdural Hematoma ◽  
Magnetic Resonance Images ◽  
Mr Images ◽  
Inner Membrane ◽  
Content Type ◽  
Black Band ◽  
Fine Print

Object. The cause and indication for enlargement of chronic subdural hematomas (CSDHs) have remained unresolved. The authors observed a black band on the inner membrane of a CSDH on T2*-weighted magnetic resonance (MR) images obtained in patients with symptoms. After surgical treatment, the band disappeared. The T2*-weighted sequence of MR imaging is an excellent diagnostic tool for detecting ferromagnetic substances, but it is rarely performed in cases of a CSDH. The authors speculate that the black band may be associated with the development of CSDH. Methods. To investigate how the black band observed on T2*-weighted MR images contributes to the development of a CSDH, 59 lesions in 50 patients with CSDH (41 men and nine women, mean age 70 ± 11 years [range 48–93 years]) were investigated prospectively. The incidence of black bands on the first T2*-weighted MR image obtained in patients with symptomatic CSDH was 97% (31 of 32 CSDHs), which was significantly higher than that associated with asymptomatic CSDH (11% [three of 27 CSDHs], p < 0.001). The black bands associated with symptomatic CSDH disappeared soon after surgical treatment in 31 CSDHs and became fainter in another. In two instances the CSDH recurred with reappearance of the band. Twenty-four of 27 asymptomatic CSDHs had no accompanying black band. Follow-up MR images demonstrated a later formation of bands in two of 24 asymptomatic CSDHs that enlarged to symptomatic size. Logistic regression analysis revealed that the heterogeneity and thickness of the CSDH on computerized tomography scans were independently and significantly associated with the black band. Conclusions. The dynamics of the black band may depend on the enlargement or shrinkage of the CSDH.

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.

scholarly journals Chronic, treatment-resistant depression and right fronto-striatal atrophy

2002 ◽  
Vol 180 (5) ◽  
pp. 434-440 ◽  
Author(s):  
P. J. Shah ◽  
M. F. Glabus ◽  
G. M. Goodwin ◽  
K. P. Ebmeier
Keyword(s):  
Magnetic Resonance ◽  
Treatment Resistance ◽  
Volumetric Analysis ◽  
Magnetic Resonance Images ◽  
Severe Illness ◽  
Cumulative Number ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression ◽  
Mri Changes

BackgroundTreatment-resistant depression (TRD) is relatively common but its neurobiological basis is poorly understood. Fronto-striatal structural brain changes have been reported in patients with depression but their association with treatment resistance and chronicity has not been established.MethodMagnetic resonance images of 20 patients with TRD were compared with images of 20recovered patients and 20 healthy controls. Images were compared using a voxel-based analysis (VBA) method; the results were validated by conventional volumetric analysis. The clinical associations of magnetic resonance imaging (MRI) changes with illness duration and severity were examined by VBA.ResultsOnly the TRD group exhibited right fronto-striatal atrophy, and subtle MRI changes in the left hippocampus on VBA. Atrophy was confirmed on volumetric analysis, the degree correlating with the cumulative number of electroconvulsive therapy (ECT) treatments received, suggesting an acquired deficit.ConclusionsThis is the first study to demonstrate fronto-striatal atrophy in patients with depression with poor outcome; the atrophy is more marked in those with more severe illness.

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