Microvascular Decompression in the Treatment of Trigeminal Neuralgia Caused by Vertebrobasilar Ectasia

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 330-337 ◽  
Author(s):  
Nasser M.F. El-Ghandour
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Nerve Compression ◽  
Resonance Imaging ◽  
Duration Of Symptoms ◽  
Vertebrobasilar Artery ◽  
The Mean

Abstract BACKGROUND Vertebrobasilar ectasia (VBE) is a rare cause of trigeminal neuralgia (TN). It occurs in about 2% of all patients. OBJECTIVE This study reviewed the clinical features, radiological concomitants, and surgical findings of VBE and evaluate the microsurgical decompression procedure as a surgical line of treatment of the associated TN. METHODS Ten patients with TN caused by VBE and treated by microvascular decompression are the subject of this study. The study consisted of 6 men and 4 women with a mean age of 54 years. The mean duration of symptoms was 4.5 years. TN was the only symptom in 6 patients; it was associated with hemifacial spasm in 4. Arterial hypertension was present in 6 patients. Multiplanar high-resolution magnetic resonance imaging showed the accurate location and course of the ectatic vessel. Magnetic resonance angiography and digital subtraction angiography confirmed the diagnosis. Surgery demonstrated fifth nerve compression by an ectatic and tortuous vertebrobasilar artery in all cases and seventh nerve compression in 4 cases. Teflon felt was placed between the ectatic artery and compressed nerves. RESULTS There was complete resolution of TN in 8 patients (80%) and hemifacial spasm in 3 (75%) without medication. Four of 6 hypertensive patients (66.7%) achieved normotension without medication. There was no recurrence of symptoms in the mean follow-up period of 7.8 years. CONCLUSION Microvascular decompression is recommended for the treatment of TN caused by VBE if medical treatment has failed, if the patient is suitable for general anesthesia, and if there is evidence of vascular compression of the trigeminal nerve on magnetic resonance imaging.

scholarly journals Correlation between Preoperative Magnetic Resonance Imaging Signal Intensity Changes and Clinical Outcomes in Patients Surgically Treated for Cervical Myeloradiculopathy

2017 ◽  
Vol 11 (2) ◽  
pp. 174-180 ◽  
Author(s):  
Chaitanya Baban Chikhale ◽  
Ketan Shripad Khurjekar ◽  
Ashok Kumar Shyam ◽  
Parag Kantilal Sancheti
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Signal Intensity ◽  
Neurological Status ◽  
Resonance Imaging ◽  
Duration Of Symptoms ◽  
Japanese Orthopedic Association ◽  
Canal Stenosis ◽  
Operative Outcomes ◽  
The Mean

<sec><title>Study Design</title><p>This was a single surgeon, single center-based retrospective study with prospective data collection.</p></sec><sec><title>Purpose</title><p>To assess the correlation between T2-weighted magnetic resonance imaging (MRI) signal intensity (SI) changes and factors such as age, duration of symptoms, baseline modified Japanese Orthopedic Association (mJOA) score and to determine its prognostic value in predicting recovery after surgery.</p></sec><sec><title>Overview of Literature</title><p>Whether intramedullary cord T2-weighted MRI SI changes can predict operative outcomes of cervical myeloradiculopathy remains debatable, with only a few prospective studies analyzing the same.</p></sec><sec><title>Methods</title><p>Forty-six consecutive patients who underwent cervical myeloradiculopathy were included and were followed up for an average of 1 year. Preoperative T2-weighted MRI SI grading was performed for all patients. The correlation between MRI SI changes and age, duration of symptoms, preoperative mJOA score, and mJOA score at 1-year follow-up were analyzed.</p></sec><sec><title>Results</title><p>Fifteen patients had single-level (21.73%) or double-level (10.86%) prolapsed discs; 54.34% had degenerative cervical spondylosis with canal stenosis or multilevel disc prolapse and 13.07% had ossified posterior longitudinal ligaments. The mean age was 56.17±9.53 years (range, 35–81 years). The mean baseline mJOA score was 10.83±2.58 (range, 6–16), which postoperatively improved to 13.59±2.28 (range, 8–17; <italic>p</italic>&lt;0.001). There was a statistically significant correlation between mJOA score at 1 year and MRI T2 SI grading (<italic>p</italic>=0.017).</p></sec><sec><title>Conclusions</title><p>Patients with longer symptom durations had high grades of intramedullary cord T2-weighted MRI SI changes. Age and preoperative neurological status were not significantly correlated with the existence of intramedullary cord SI changes. However, patients without or with mild and diffuse intramedullary cord T2-weighted MRI SI changes had better postoperative neurological recovery than those with sharp and focal SI changes.</p></sec>

Transient Magnetic Resonance Imaging Signal Alterations in the Brainstem after Microvascular Decompression for Trigeminal Neuralgia: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 55 (4) ◽  
pp. E1023-E1026 ◽  
Author(s):  
M Jafer Ali ◽  
Stephen Gebarski ◽  
B Gregory Thompson
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Signs And Symptoms ◽  
Transient Signal ◽  
Recurrent Pain ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri

Abstract OBJECTIVE AND IMPORTANCE: We present a case of transient signal alterations along the brainstem path of the trigeminal nerve after microvascular decompression in a patient with trigeminal neuralgia. Such signal changes have been previously reported to represent infarction, but in our patient, they seemed to represent reactive neural and nuclear changes attributable to operative manipulation. CLINICAL PRESENTATION: A 43-year-old woman presented with gradually increasing, medically refractory recurrent trigeminal neuralgia 16 months after initial successful microvascular decompression for trigeminal neuralgia. Repeat microvascular decompression resulted initially in complete pain relief; however, her pain suddenly returned on the 3rd postoperative day. Magnetic resonance imaging (MRI) of this recurrent pain revealed new signal alterations along the brainstem path of the trigeminal nerve. Other than marked reduction in her trigeminal neuralgia, the patient had no postoperative alterations of trigeminal sensory or motor function. INTERVENTION: The patient's residual postoperative trigeminal neuralgia was successfully treated with carbamazepine. Because of the absence of worrisome signs and symptoms corresponding to the MRI signal alterations, no additional therapy was elected. Follow-up MRI in 1 month revealed near-complete resolution of the postoperative signal alterations along the brainstem path of the trigeminal nerve. CONCLUSION: MRI signal alterations along the brainstem path of the trigeminal nerve after microvascular decompression may be only reactive and do not always represent infarction. Depending on the clinical picture, observation may be all that is necessary in such cases.

The Kaplan Fibers of the Iliotibial Band Can Be Identified on Routine Knee Magnetic Resonance Imaging

2019 ◽  
Vol 47 (12) ◽  
pp. 2895-2903 ◽  
Author(s):  
Lachlan Batty ◽  
Jerome Murgier ◽  
Richard O’Sullivan ◽  
Kate E. Webster ◽  
Julian A. Feller ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Sagittal Plane ◽  
Interobserver Reliability ◽  
Joint Line ◽  
Coronal Plane ◽  
Iliotibial Band ◽  
Resonance Imaging ◽  
Lateral Gastrocnemius ◽  
The Mean

Background: The Kaplan fibers (KFs) of the iliotibial band have been suggested to play a role in anterolateral rotational instability of the knee, particularly in the setting of an anterior cruciate ligament (ACL) rupture. Description of the normal magnetic resonance imaging (MRI) anatomy of the KFs may facilitate subsequent investigation into the MRI signs of injury. Purpose: To assess if the KF complex can be identified on 3-T MRI using standard knee protocols. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: 3-T MRI scans of 50 ACL-intact knees were reviewed independently by a musculoskeletal radiologist and 2 orthopaedic surgeons. Identification of the KFs was based on radiological diagnostic criteria developed a priori. Identification of the KFs in the sagittal, coronal, and axial planes was recorded. Interobserver reliability was assessed using the Kappa statistic. Detailed anatomy including distance to the joint line and relationship to adjacent structures was recorded. Results: The mean patient age was 43 years (range, 15-81 years), 58% were male, and 50% were right knees. The KFs were identified by at least 2 reviewers on the sagittal images in 96% of cases, on the axial images in 76% of cases, and on the coronal images in 4% of cases. The mean distance from the KF distal femoral insertion to the lateral joint line was 50.1 mm (SD, 6.6 mm) and the mean distance to the lateral gastrocnemius tendon origin was 10.8 mm (SD, 8.6 mm). The KFs were consistently identified immediately anterior to the superior lateral geniculate artery on sagittal imaging. Interobserver reliability for identification was best in the sagittal plane (Kappa 0.5) and worst in the coronal plane (Kappa 0.1). Conclusion: The KF complex can be identified on routine MRI sequences in the ACL-intact knee; however, there is low to moderate interobserver reliability. Imaging in the sagittal plane had the highest rate of identification and the coronal plane the lowest. There is a consistent relationship between the most distal KF femoral attachment and the lateral joint line, lateral gastrocnemius tendon, and superior lateral geniculate artery.

scholarly journals Demyelination and remyelination detected in an alternative cuprizone mouse model of multiple sclerosis with 7.0 T multiparameter magnetic resonance imaging

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shuang Ding ◽  
Yu Guo ◽  
Xiaoya Chen ◽  
Silin Du ◽  
Yongliang Han ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Mouse Model ◽  
Diffusion Tensor ◽  
Mean Diffusivity ◽  
Blue Staining ◽  
Resonance Imaging ◽  
The Mean ◽  
Underlying Mechanisms

AbstractThe aim of this study was to investigate the mechanisms underlying demyelination and remyelination with 7.0 T multiparameter magnetic resonance imaging (MRI) in an alternative cuprizone (CPZ) mouse model of multiple sclerosis (MS). Sixty mice were divided into six groups (n = 10, each), and these groups were imaged with 7.0 T multiparameter MRI and treated with an alternative CPZ administration schedule. T2-weighted imaging (T2WI), susceptibility-weighted imaging (SWI), and diffusion tensor imaging (DTI) were used to compare the splenium of the corpus callosum (sCC) among the groups. Prussian blue and Luxol fast blue staining were performed to assess pathology. The correlations of the mean grayscale value (mGSV) of the pathology results and the MRI metrics were analyzed to evaluate the multiparameter MRI results. One-way ANOVA and post hoc comparison showed that the normalized T2WI (T2-nor), fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) values were significantly different among the six groups, while the mean phase (Φ) value of SWI was not significantly different among the groups. Correlation analysis showed that the correlation between the T2-nor and mGSV was higher than that among the other values. The correlations among the FA, RD, MD, and mGSV remained instructive. In conclusion, ultrahigh-field multiparameter MRI can reflect the pathological changes associated with and the underlying mechanisms of demyelination and remyelination in MS after the successful establishment of an acute CPZ-induced model.

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