Microstructural changes in the trigeminal nerve of patients with episodic migraine assessed using magnetic resonance imaging

Abstract Background: There is histological evidence of microstructural changes in the zygomaticotemporal branch of the trigeminal nerve in migraineurs. This raises the possibility that altered trigeminal nerve properties contribute to migraine pathophysiology. Whilst it is not possible to explore the anatomy of small trigeminal nerve branches it is possible to explore the anatomy of the trigeminal root entry zone using magnetic resonance imaging in humans. The aim of this investigation is to assess the microstructure of the trigeminal nerve in vivo to determine if nerve alterations occur in individuals with episodic migraine. Methods: In 39 migraineurs and 39 matched controls, T1-weighted anatomical images were used to calculate the volume (mm3) and maximal cross-sectional area of the trigeminal nerve root entry zone; diffusion tensor images were used to calculate fractional anisotropy, mean diffusion, axial diffusion and radial diffusion. Results: There were significant differences between the left and right nerve of controls and migraineurs with respect to volume and not cross-sectional area. Migraineurs displayed reduced axial diffusion in the right nerve compared to the left nerve and reduced fractional anisotropy in the left nerve compared to left controls. Furthermore, although there were no differences in mean diffusion or radial diffusion, regional analysis of the nerve revealed significantly greater radial diffusion in the rostral portion of the left trigeminal nerve in migraineurs compared with controls. Conclusions: Migraine pathophysiology is associated with microstructural abnormalities within the trigeminal nerve that are consistent with histological evidence of altered myelin and/or organization. These peripheral nerve changes may provide further insight into migraine pathophysiology and enable a greater understanding for targeted treatments of pain alleviation.

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Microstructural changes in the trigeminal nerve of patients with episodic migraine assessed using magnetic resonance imaging

10.21203/rs.3.rs-16841/v1 ◽

2020 ◽

Author(s):

Tiffani J. Mungoven ◽

Noemi Meylakh ◽

Kasia Marcizewski ◽

Vaughan G. Macefield ◽

Paul M. Macey ◽

...

Keyword(s):

Trigeminal Nerve ◽

Episodic Migraine ◽

Radial Diffusion ◽

Sectional Area ◽

Resonance Imaging ◽

Cross Sectional ◽

Entry Zone ◽

Histological Evidence ◽

Root Entry Zone ◽

Migraine Pathophysiology

Abstract Background There is histological evidence of microstructural changes in the zygomaticotemporal branch of the trigeminal nerve in migraineurs. This raises the possibility that altered trigeminal nerve properties contribute to migraine pathophysiology. Whilst it is not possible to explore the anatomy of small trigeminal nerve branches it is possible to explore the anatomy of the trigeminal root entry zone using magnetic resonance imaging in humans. The aim of this investigation is to assess the microstructure of the trigeminal nerve in vivo to determine if nerve alterations occur in individuals with episodic migraine. Methods In 39 migraineurs and 39 matched controls, T1-weighted anatomical images were used to calculate the volume (mm 3 ) and maximal cross-sectional area of the trigeminal nerve root entry zone; diffusion tensor images were used to calculate fractional anisotropy, mean diffusion, axial diffusion and radial diffusion. Results Whilst there were no significant differences between controls and migraineurs with respect to volume or cross-sectional area, migraineurs displayed reduced fractional anisotropy. Furthermore, although there were no differences in average mean diffusion, axial diffusion or radial diffusion, regional analysis of the nerve revealed significantly greater mean diffusion and radial diffusion in the rostral portion of the trigeminal nerve in migraineurs compared with controls. Conclusions Migraine pathophysiology is associated with microstructural abnormalities within the trigeminal nerve that are consistent with histological evidence of altered myelin and/or organization. These peripheral nerve changes may provide further insight into migraine pathophysiology and enable a greater understanding for targeted treatments of pain alleviation.

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Degree of distal trigeminal nerve atrophy predicts outcome after microvascular decompression for Type 1a trigeminal neuralgia

Journal of Neurosurgery ◽

10.3171/2014.12.jns142086 ◽

2015 ◽

Vol 123 (6) ◽

pp. 1512-1518 ◽

Cited By ~ 10

Author(s):

Yifei Duan ◽

Jennifer Sweet ◽

Charles Munyon ◽

Jonathan Miller

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Microvascular Decompression ◽

Cross Sectional Area ◽

Vascular Compression ◽

Sectional Area ◽

Cross Sectional ◽

Entry Zone ◽

Root Entry Zone ◽

Distal Nerve

OBJECT Trigeminal neuralgia is often associated with nerve atrophy, in addition to vascular compression. The authors evaluated whether cross-sectional areas of different portions of the trigeminal nerve on preoperative imaging could be used to predict outcome after microvascular decompression (MVD). METHODS A total of 26 consecutive patients with unilateral Type 1a trigeminal neuralgia underwent high-resolution fast-field echo MRI of the cerebellopontine angle followed by MVD. Preoperative images were reconstructed and reviewed by 2 examiners blinded to the side of symptoms and clinical outcome. For each nerve, a computerized automatic segmentation algorithm was used to calculate the coronal cross-sectional area at the proximal nerve near the root entry zone and the distal nerve at the exit from the porus trigeminus. Findings were correlated with outcome at 12 months. RESULTS After MVD, 17 patients were pain free and not taking medications compared with 9 with residual pain. Across all cases, the coronal cross-sectional area of the symptomatic trigeminal nerve was significantly smaller than the asymptomatic side in the proximal part of the nerve, which was correlated with degree of compression at surgery. Atrophy of the distal trigeminal nerve was more pronounced in patients who had residual pain than in those with excellent outcome. Among the 7 patients who had greater than 20% loss of nerve volume in the distal nerve, only 2 were pain free and not taking medications at long-term follow-up. CONCLUSIONS Trigeminal neuralgia is associated with atrophy of the root entry zone of the affected nerve compared with the asymptomatic side, but volume loss in different segments of the nerve has very different prognostic implications. Proximal atrophy is associated with vascular compression and correlates with improved outcome following MVD. However, distal atrophy is associated with a significantly worse outcome after MVD.

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Identification of a Persistent Primitive Trigeminal Artery Following the Transposition Technique for Trigeminal Neuralgia: A Case Report

Pain Research and Management ◽

10.1155/2011/987865 ◽

2011 ◽

Vol 16 (5) ◽

pp. 357-359 ◽

Cited By ~ 2

Author(s):

Naoki Kato ◽

Toshihide Tanaka ◽

Hiroki Sakamoto ◽

Takao Arai ◽

Yuzuru Hasegawa ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Trigeminal Artery ◽

Resonance Imaging ◽

Entry Zone ◽

Root Entry Zone ◽

Persistent Primitive Trigeminal Artery ◽

Orbital Pain ◽

Primitive Trigeminal Artery

Trigeminal neuralgia is lancinating pain of a few seconds duration triggered by minor sensory stimuli such as speaking, chewing or even a breeze on the face. Vascular compression of the trigeminal nerve at the root entry zone and other vessels has been implicated in its cause. Despite the initial success of medical treatment in some cases, however, many patients become refractory over time and eventually require surgical intervention. This report describes a case involving a 62-year-old woman who presented with right orbital pain provoked by, among others, exercise and cold. Medication proved to be ineffective and, after magnetic resonance imaging, microvascular decompression and surgical observation, the diagnosis became clearer. The case highlights the importance of preoperative imaging and careful intraoperative findings to determine whether variant arteries are responsible for trigeminal neuralgia.A patient who presented with trigeminal neuralgia associated with a persistent primitive trigeminal artery (PPTA) is presented. A 62-year-old woman suffering from right orbital pain was admitted to the hospital. Medical treatment for three months was ineffective, and her neuralgia had deteriorated and gradually spread in the maxillary division. Magnetic resonance imaging demonstrated the flow void signal attached to the right trigeminal nerve. Thus, microvascular decompression was performed. The superior cerebellar artery was the responsible artery, and it was transposed to decompress the trigeminal nerve. After this manoeuvre, an artery was identified running parallel to the trigeminal nerve toward Meckel’s cave. The artery, which turned out to be a PPTA, communicated with the basilar artery. The PPTA was carefully observed, and it was found not to be the artery causing the neuralgia because it did not compress the nerve at surgical observation. No additional procedure between the PPTA and the trigeminal nerve was performed. The patient’s symptom improved dramatically following surgery, and her postoperative course was uneventful. Postoperative three-dimensional computed tomography showed the PPTA. The findings in the present case suggest that transposition of the responsible artery effectively decompresses the root entry zone and assists in determining whether the PPTA is affecting the trigeminal nerve.

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Significance of the cerebellopontine cistern cross-sectional area and trigeminal nerve anatomy in trigeminal neuralgia: an anatomical study using magnetic resonance imaging

Turkish Neurosurgery ◽

10.5137/1019-5149.jtn.27735-19.2 ◽

2019 ◽

Author(s):

Aylin Gunesli ◽

Kadir Tufan

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Anatomical Study ◽

Cross Sectional Area ◽

Sectional Area ◽

Resonance Imaging ◽

Cross Sectional

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Cavernous Malformation of the Trigeminal Nerve Manifesting with Trigeminal Neuralgia: Case Report

Neurosurgery ◽

10.1227/01.neu.0000154063.05728.7e ◽

2005 ◽

Vol 56 (3) ◽

pp. E623-E623 ◽

Cited By ~ 27

Author(s):

Vivek R. Deshmukh ◽

Jonathan S. Hott ◽

Peyman Tabrizi ◽

Peter Nakaji ◽

Iman Feiz-Erfan ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Nerve Root ◽

Facial Pain ◽

Clinical Presentation ◽

Cavernous Malformation ◽

Resonance Imaging ◽

Cavernous Malformations ◽

Entry Zone ◽

Root Entry Zone

Abstract OBJECTIVE AND IMPORTANCE: We describe a patient with a cavernous malformation within the trigeminal nerve at the nerve root entry zone who presented with trigeminal neuralgia. CLINICAL PRESENTATION: A 52-year-old woman sought treatment after experiencing dizziness and lancinating left facial pain for almost a year. Neurological examination revealed diminished sensation in the distribution of the trigeminal nerve on the left. Magnetic resonance imaging demonstrated a minimally enhancing lesion affecting the trigeminal nerve. INTERVENTION: The patient underwent a retrosigmoid craniotomy. At the nerve root entry zone, the trigeminal nerve was edematous with hemosiderin staining. The lesion, which was resected with microsurgical technique, had the appearance of a cavernous malformation on gross and histological examination. The patient's pain improved significantly after resection. CONCLUSION: Cavernous malformations can afflict the trigeminal nerve and cause trigeminal neuralgia. Microsurgical excision can be performed safely and is associated with improvement in symptoms.

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Use of Cardiac Magnetic Resonance Imaging Based Measurements of Inferior Vena Cava Cross-Sectional Area in the Diagnosis of Pericardial Constriction

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2014.12.007 ◽

2015 ◽

Vol 66 (3) ◽

pp. 231-237 ◽

Cited By ~ 2

Author(s):

Kate Hanneman ◽

Paaladinesh Thavendiranathan ◽

Elsie T. Nguyen ◽

Hadas Moshonov ◽

Rachel Wald ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cardiac Magnetic Resonance ◽

Inferior Vena ◽

Vena Cava ◽

Area Ratio ◽

Cross Sectional Area ◽

Sectional Area ◽

Resonance Imaging ◽

Cross Sectional ◽

Aortic Area

Purpose To evaluate the value of cardiac magnetic resonance imaging (MRI)–based measurements of inferior vena cava (IVC) cross-sectional area in the diagnosis of pericardial constriction. Methods Patients who had undergone cardiac MRI for evaluation of clinically suspected pericardial constriction were identified retrospectively. The diagnosis of pericardial constriction was established by clinical history, echocardiography, cardiac catheterization, intraoperative findings, and/or histopathology. Cross-sectional areas of the suprahepatic IVC and descending aorta were measured on a single axial steady-state free-precession (SSFP) image at the level of the esophageal hiatus in end-systole. Logistic regression and receiver-operating curve (ROC) analyses were performed. Results Thirty-six patients were included; 50% (n = 18) had pericardial constriction. Mean age was 53.9 ± 15.3 years, and 72% (n = 26) were male. IVC area, ratio of IVC to aortic area, pericardial thickness, and presence of respirophasic septal shift were all significantly different between patients with constriction and those without ( P < .001 for all). IVC to aortic area ratio had the highest odds ratio for the prediction of constriction (1070, 95% confidence interval [8.0-143051], P = .005). ROC analysis illustrated that IVC to aortic area ratio discriminated between those with and without constriction with an area under the curve of 0.96 (95% confidence interval [0.91-1.00]). Conclusions In patients referred for cardiac MRI assessment of suspected pericardial constriction, measurement of suprahepatic IVC cross-sectional area may be useful in confirming the diagnosis of constriction when used in combination with other imaging findings, including pericardial thickness and respirophasic septal shift.

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