scholarly journals To be or not to be a neurovascular conflict: importance of the preoperative identification of the neurovascular conflict in the trigeminal neuralgia

2016 ◽  
Vol 30 (3) ◽  
pp. 336-344
Author(s):  
Dana Mihaela Turliuc ◽  
B. Dobrovăţ ◽  
A. I. Cucu ◽  
Ş. Turliuc ◽  
Daniela Trandafir ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Surgical Approach ◽  
Neurovascular Compression ◽  
Neurovascular Conflict

Abstract The trigeminal neuralgia caused by neurovascular compression is a neurosurgical pathology requiring the preoperative identification as exact as possible of the neurovascular conflict. In this case, neuroimaging is very useful, as it allows not only the determination of the neurovascular conflict of the trigeminal nerve, but also the correct indication of an adequate surgical approach.

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.

MRI features of responsible contacts in vascular compressive trigeminal neuralgia and prediction modeling

2021 ◽  
pp. 028418512098397
Author(s):  
Yufei Zhao ◽  
Jianhua Chen ◽  
Rifeng Jiang ◽  
Xue Xu ◽  
Lin Lin ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Predictive Model ◽  
Trigeminal Nerve ◽  
Roc Curve ◽  
Neurovascular Compression ◽  
Diagnostic Efficiency ◽  
Mri Features ◽  
Vascular Origin ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Characteristics

Background Multiple neurovascular contacts in patients with vascular compressive trigeminal neuralgia often challenge the diagnosis of responsible contacts. Purpose To analyze the magnetic resonance imaging (MRI) features of responsible contacts and establish a predictive model to accurately pinpoint the responsible contacts. Material and Methods Sixty-seven patients with unilateral trigeminal neuralgia were enrolled. A total of 153 definite contacts (45 responsible, 108 non-responsible) were analyzed for their MRI characteristics, including neurovascular compression (NVC) grading, distance from pons to contact (Dpons-contact), vascular origin of compressing vessels, diameter of vessel (Dvessel) and trigeminal nerve (Dtrigeminal nerve) at contact. The MRI characteristics of the responsible and non-responsible contacts were compared, and their diagnostic efficiencies were further evaluated using a receiver operating characteristic (ROC) curve. The significant MRI features were incorporated into the logistics regression analysis to build a predictive model for responsible contacts. Results Compared with non-responsible contacts, NVC grading and arterial compression ratio (84.44%) were significantly higher, Dpons-contact was significantly lower at responsible contacts ( P < 0.001, 0.002, and 0.033, respectively). NVC grading had a highest diagnostic area under the ROC curve (AUC) of 0.742, with a sensitivity of 64.44% and specificity of 75.00%. The logistic regression model showed a higher diagnostic efficiency, with an AUC of 0.808, sensitivity of 88.89%, and specificity of 62.04%. Conclusion Contact degree and position are important MRI features in identifying the responsible contacts of the trigeminal neuralgia. The logistic predictive model based on Dpons-contact, NVC grading, and vascular origin can qualitatively improve the prediction of responsible contacts for radiologists.

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 neuralgia resulting from auditory brainstem implant cable compression

2011 ◽  
Vol 114 (1) ◽  
pp. 186-188 ◽  
Author(s):  
Marc S. Schwartz ◽  
Derald E. Brackmann ◽  
Eric P. Wilkinson ◽  
John L. Go ◽  
Felipe Santos
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Imaging Study ◽  
Neurofibromatosis Type ◽  
Auditory Brainstem ◽  
Fast Imaging ◽  
Neurovascular Compression ◽  
Auditory Brainstem Implant ◽  
Maximal Medical Therapy

The authors report a case of neurofibromatosis Type 2 presenting with symptoms of trigeminal neuralgia refractory to medical management following placement of an auditory brainstem implant (ABI). Physical examination and history revealed trigeminal neuralgia. A 3D FIESTA (fast imaging employing steady-state acquisition) MR imaging study demonstrated compression of the trigeminal nerve by an ABI cable. After maximal medical therapy, a retrosigmoid microscopic decompression of the trigeminal nerve achieved complete symptom resolution. This is the first report of an ABI cable becoming displaced, resulting in neurovascular compression. This case demonstrates that trigeminal neuralgia can result from nonvascular compression of the trigeminal nerve.

scholarly journals MICROVASCULAR DECOMPRESSION IN THE TREATMENT OF PATIENTS WITH TRIGEMINAL NEURALGIA

2019 ◽  
Vol 19 (1-2) ◽  
pp. 101-106
Author(s):  
D. M Lazarchuk ◽  
G. N Alekseev ◽  
O. O Kamadey ◽  
S. N Chemidronov
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Nerve Root ◽  
Treatment Method ◽  
Neurovascular Conflict ◽  
Neurosurgical Department ◽  
Trigeminal Nerve Root ◽  
Trigeminal Root ◽  
Cranial Fossa

This work highlights the main variant treatment of patients with trigeminal neuralgia, with a proven neurovascular conflict, microvascular decompression of the trigeminal root. Microvascular decompression is the main radical treatment method which allows to relieve hyperfunctional syndrome manifested by prosopalgia. In the course of this study, the variant anatomy of the neurovascular conflict in patients with trigeminal neuralgia was described in detail. The group of patients whose clinical diagnosis at the stage of selection was based on a neurological examination and taking into account the progression of symptoms as well as the performed instrumental examination (CT angiography). The results are described in the article. Atrophic changes of the root of the trigeminal nerve are visualized and described. The nature of its blood supply is classified according to the type of the origin of the artery or arterial branches of the trigeminal nerve root. The main types of neurovascular conflict classified according to the type of blood vessel are presented. Variant neuroanatomy of the trigeminal nerve root as well as the interaction with the arteries of the vertebrobasilar basin and the veins of the posterior cranial fossa are described. The course of microvascular decompression of the trigeminal nerve root, used in the neurosurgical department of Samara Regional Clinical Hospital n.a. V.D. Seredavin is described

scholarly journals Trigeminal neuralgia caused by an arachnoid cyst in Meckel’s cave: A case report and literature review

2021 ◽  
Vol 12 ◽  
pp. 45
Author(s):  
Shunya Hanakita ◽  
Soichi Oya ◽  
Toru Matsui
Keyword(s):  
Literature Review ◽  
Trigeminal Neuralgia ◽  
Arachnoid Cyst ◽  
Trigeminal Nerve ◽  
Neurovascular Compression ◽  
Mr Images ◽  
Meckel’S Cave ◽  
Suboccipital Craniotomy ◽  
Meckel's Cave ◽  
Asymmetric Shape

Background: We present a rare case of trigeminal neuralgia (TN) caused by an arachnoid cyst (AC) in Meckel’s cave (MC). Case Description: A 35-year-old man presented with facial pain in the left maxillary and mandibular regions. Since the initial magnetic resonance (MR) imaging showed no apparent offending vessels or tumors, the patient was diagnosed with idiopathic TN, for which carbamazepine was initially effective. When his pain worsened, he was referred to our hospital. A slightly asymmetric shape of MC and distorted course of the trigeminal nerve was confirmed on the initial and repeat MR images. His pain was characterized as electric-shock-like pain, which was triggered by touching the face. Under the tentative diagnosis of an AC confined to MC compressing the trigeminal nerve, the exploration of MC through suboccipital craniotomy was performed. Intraoperatively, the AC was identified in the rostral portion of MC. The indentation of the trigeminal nerve was also observed at the orifice of MC, indicating severe compression by the AC. The wall of the AC was fenestrated. The patient’s pain was relieved immediately after surgery. Postoperative MR images showed that the course of the trigeminal nerve was straightened. Although our literature review found five similar cases, the size of the AC was the smallest in our case. Conclusion: Although it is rare, the AC confined to MC can cause TN. The findings of this study emphasize the importance of evaluating subtle radiological findings of compression on the trigeminal nerve in cases of TN seemingly without neurovascular compression.

127 A Novel Scoring System for Preoperative Prediction for Pain-Free Survival After Microsurgery for Trigeminal Neuralgia: TN-MVD Score

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 228-229 ◽  
Author(s):  
Frances Hardaway ◽  
Hanna Gustafsson ◽  
Katherine Holste ◽  
Kim J Burchiel ◽  
Ahmed M T Raslan
Keyword(s):  
Trigeminal Neuralgia ◽  
Scoring System ◽  
Cox Regression ◽  
Outcome Data ◽  
Neurovascular Compression ◽  
Neurovascular Conflict ◽  
Radiographic Findings ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Internal Neurolysis

Abstract INTRODUCTION Pain relief following microsurgery for trigeminal neuralgia (TN) may be related to multiple factors including pain type, degree of neurovascular conflict, arterial compression, and location of compression. The objective of this study was to construct a predictive scoring system based on clinical and radiographic factors that can preoperatively prognosticate long-term outcomes in TN following surgery. METHODS 275 patients with Type 1 or Type 2 TN underwent microvascular decompression (MVD) or internal neurolysis (IN) following a preoperative high-resolution MRI. Outcome data was obtained retrospectively by chart review and/or phone follow-up. Characteristics of neurovascular conflict were obtained from preoperative MRI. Factors that resulted in a probability value of <0.05 on univariate logistic regression analyses were entered into a multivariate cox regression analysis in a backward stepwise fashion. For the multivariate analysis, significance at the 0.15 level was used. A prognostic system was then devised with three possible scores (0/1, 2, or 3) and survival analyses were conducted. RESULTS >Univariate predictors of pain-free survival were pain type (P = 0.013), presence of any vessel (P = 0.042), and neurovascular compression severity (0.038). Scores of 0/1, 2, and 3 were found to be significantly different in regard to pain-free survival (log rank, P = 0.008). At 5 and 10 years there were 42, 57, and 72% and 42,52, and 58%, pain free survival in groups 0/1, 2, and 3, respectively. TN1 patients with severe neurovascular conflict (score of 3) had the best outcome, which was significantly better that TN1 patients without neurovascular conflict (score of 1) (log rank, P = 0.005). Severe neurovascular conflict is more likely to have arterial compression (99%) (P< 0.001). CONCLUSION Pain-free survival of TN patients after microsurgery can be predicted in a step-wise statistically significant fashion, by a simple scoring system based on preoperative clinical and radiographic findings.

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.

scholarly journals Radiosurgical treatment of trigeminal neuralgia: experience of the Radiosurgery Center of the N.V. Sklifosovsky Research Institute for Emergency Medicine

2019 ◽  
Vol 21 (3) ◽  
pp. 12-20
Author(s):  
A. S. Tokarev ◽  
M. V. Sinkin ◽  
E. N. Rozhnova ◽  
V. N. Stepanov ◽  
V. A. Rak
Keyword(s):  
Multiple Sclerosis ◽  
Emergency Medicine ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Type I ◽  
Drug Resistant ◽  
Neurovascular Conflict ◽  
Study Objective ◽  
Research Institute

The study objective is to evaluate early results of radiosurgical treatment (RST) of drug-resistant trigeminal neuralgia (TN) of various etiology.Materials and methods. Between 01.01.2016 and 01.07.2018 at the Radiosurgery Center of the N.V. Sklifosovsky Research Institute for Emergency Medicine, 14 patients with drug-resistant TN underwent RST. Per magnetic resonance imaging, prior to treatment 7 patients had neurovascular conflict, 2 had demyelination of the root of the trigeminal nerve due to multiple sclerosis, and 5 patients showed no pathologies of the brain. Irradiation of the cisternal portion of the trigeminal nerve at the distance of 7.5 mm from the entry into the brainstem with prescribed dose of 90 Gy was performed. Follow-up period was 8–20 months. The difference in fractional anisotropy (FA) at the affected and healthy sides was evaluated in patients with TN prior to RST to divide them into 2 groups: with significant FA decrease and with moderate FA decrease.Results. All patients who underwent RST with PD >80 Gy (85.7 %) noted decreased level of pain or its full disappearance. In 11 (78.5 %) patients, anesthetic effect manifested itself 3–6 weeks after RST, in 1–3 months after RST. Full analgesic effect was achieved in a patient with idiopathic type II TN (PD 84 Gy) 3 months after RST, in a patient with neurovascular conflict and type I TN (PD 86 Gy) 6 weeks after RST, in a patient with multiple sclerosis and type I TN (PD 81 Gy) 3 weeks after RST. In the last-mentioned patient, pain returned 12 months after RST but with lower intensity. In 2 (14.3 %) patients (PD 80 Gy), no positive effect was observed in 6 months of follow up. Hypesthesia of a face area (RST complication) was diagnosed in only 1 (7.2 %) patient 8 months after RST, and it persisted for 6 weeks gradually regressing. There was no statistically significant correlation between FA decrease and RST outcome, but it was observed that outcome was more favorable in patients with moderately decreased FA.Conclusion. RST of drug-resistant forms of TN with PD >80 Gy significantly reduces pain syndrome 3–6 weeks after treatment and is characterized by low risk of complications.

scholarly journals MRI-derived neurovascular compression score provides the indication of surgical treatment of patients with primary trigeminal neuralgia: A validated multi-center study

2020 ◽  
Author(s):  
Jian Shen ◽  
Wenli Zhou ◽  
Weiqiang Shen ◽  
Huimei Zhang ◽  
Xianfang Hu ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Scoring System ◽  
Diagnostic Performance ◽  
False Positive Rate ◽  
Radiological Finding ◽  
Neurovascular Compression ◽  
Mri Findings ◽  
Tof Mra

Abstract Background The radiological assessment of neurovascular compression (NVC) is various regarding MRI techniques and assessing methods in patients with trigeminal neuralgia (TN), and the false-positive rate of MRI findings is not low. Better MRI techniques with the NVC assessing method are warranted to be determined. This study aims to investigate the diagnostic performance of 3D TOF MRA and 3D Fast Imaging Employing Steady-state Acquisition (FIESTA) with a novel NVC scoring system in TN patients. Methods Patients with confirmed TN who underwent MRI studies before microvascular decompression (MVD) were retrospectively included into the study. A new NVC scoring system based on the contact relationship of the trigeminal nerve and the vessel was performed to assess the NVC in the symptomatic and contralateral asymptomatic side. The radiological finding was correlated with the intraoperative result to figure out the diagnostic accuracy of MRI techniques. Besides, the comparison of both sides was performed to determine the radiological indicator of MVD. Results Seventy-three TN patients were recruited, and 146 trigeminal nerve sides were analyzed. For the symptomatic sides, 69 patients had surgically confirmed offending vessels, most of which was SCA, and the positive NVC rate was 95.5%. For the contralateral side, 33 patients have been found with NVC on MRI. The NVC score of the symptomatic side was significantly higher than that of asymptomatic sides (6.7 vs. 1.6; p < 0.001). The optimal cut-off value in predicting trigeminal neuralgia was found as NVC > 4 with sensitivity and specificity of 82.2% and 98.6%, respectively. Conclusion 3D-TOF MRA and FIESTA enable a good diagnostic performance of NVC, and NVC score > 4 was identified to predict trigeminal neuralgia, suggestive of subsequent surgical treatment. Trial registration: The study has been retrospectively registered at the local ethical Institution Review Board (IRB) of Huzhou Central Hospital and Sir Run Run Shaw Hospital with the IRB number (20181108-01; Huzhou) and (20200423-43; SRRSH).

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