Microvascular Relations of the Trigeminal Nerve: An Anatomical Study

Klun, B.; Prestor, Borut

doi:10.1227/00006123-198610000-00007

Cited by 58 publications

(28 citation statements)

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“…3,8,9,11 All these arteries have the potential to cause trigeminal neuralgia. Nerve compression is often caused by a combination of vessels, including various veins, and the offending vessel may not be definitively identified during the operation.…”

Section: Discussionmentioning

confidence: 99%

Trigeminal neuralgia caused by a trigeminocerebellar artery

Amagasaki¹,

Abe

Watanabe³

et al. 2014

JNS

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T rigeminal neuralgia is considered to be a type of neurovascular compression syndrome 4,7 typically caused by compression of the trigeminal nerve by the superior cerebellar artery (SCA) or other arteries branching from the vertebral and basilar arteries, and sometimes by veins or tumors. 2,3 We report a case of trigeminal neuralgia caused by an artery that had almost encircled the nerve, which was successfully decompressed surgically, and discuss the anatomy of the offending artery and trigeminal nerve root vasculature. Case ReportHistory and Presentation. This 31-year-old woman visited our hospital because of right facial pain. She first experienced a sharp pain in the right V 2 area of her face at age 16 years. The pain was triggered by brushing her teeth or washing her face. Treatment was initiated with oral medication (carbamazepine 600 mg per day), but the pain aggravated and the affected region enlarged to include the entire right V 1 to V 3 distribution and was even easily triggered by eating and conversation.Imaging. Gradient echo MRI indicated the presence of arteries along the right trigeminal nerve (Fig. 1); MR angiography showed 3 arteries on the right side of the upper part of the basilar artery (BA) (Fig. 2 left), and further gradient echo MRI showed bilateral thin anterior inferior cerebellar arteries (AICAs) branching from the lower portion of the BA (Fig. 2 right). The 3D fusion image from the caudal side revealed an artery arising from the BA and coursing toward the right trigeminal nerve, with neurovascular conflict observed at the proximal part of the nerve root, so this artery was identified as the offending artery (Fig. 3A). On the basis of this image and another 3D image from the posterior direction, it was confirmed that the duplicated SCAs and the offending artery directly branching from the BA were congruent with the 3 arteries identified on MR angiography (Fig. 3B). A surgical view of the 3D image allowed detailed evaluation of the neurovascular complex at the nerve root (Fig. 3C).Operation and Postoperative Course. After providing informed consent, the patient underwent microvascular decompression through a right suboccipital retrosig- This 31-year-old woman presented with typical right trigeminal neuralgia caused by a trigeminocerebellar artery, manifesting as pain uncontrollable with medical treatment. Preoperative neuroimaging studies demonstrated that the offending artery had almost encircled the right trigeminal nerve. This finding was confirmed intraoperatively, and decompression was completed. The neuralgia resolved after the surgery; the patient had slight transient hypesthesia, which fully resolved within the 1st month after surgery. The neuroimaging and intraoperative findings showed that the offending artery directly branched from the upper part of the basilar artery and, after encircling and supplying tiny branches to the nerve root, maintained its diameter and coursed toward the rostral direction of the cerebellum, which indicated that the artery supplied both the trigem...

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Section: Discussionmentioning

confidence: 99%

Trigeminal neuralgia caused by a trigeminocerebellar artery

Amagasaki¹,

Abe

Watanabe³

et al. 2014

JNS

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“…Unfortunately, we do not have the information about the history of TGN in these humans analogously as in the previous publication. In the other anatomical study, Klun and Prestor [12] examined 130 specimens (65 heads) and observed 42 examples of contact and 10 instances of compression of the vessels with the REZ of the V th nerve. In the analysed group, 30 conflicts were related to arterial vessels (53.8% -SCA, 25.6% -AICA, 20.6% -the pontine branches of BA), 11 may have components of the vein, and only 1 anatomical specimen with unequivocal compression by vein vessel was found [12].…”

Section: Analysis Of the Anatomical Variations Of Neurovascular Conflictmentioning

confidence: 99%

“…The percentage is approximately 0-28%, and it depends on the number of microdecompression series [1,11,17,21,23,25,30]. It is the cause why they have concluded that vascular compression may be the predominant, but not the sole cause of TGN and the pathophysiology of pain is still unclear [12,21,23]. trigeminocerebellar artery, which is the branch of BA lying between V th nerve and the hemisphere of cerebellum.…”

Section: Analysis Of the Anatomical Variations Of Neurovascular Conflictmentioning

confidence: 99%

Trigeminal neuralgia caused by aneurysm of the posterior cerebral artery: a case description and the analysis of anatomical variety of vascular complex in the rood entry zone of trigeminal nerve

Dzierżanowski

Słoniewski

2014

Folia Morphol

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“…Fibers arising from the motor nucleus emerge from the ventral surface of pons forming the motor root of the mandibular nerve which lies anteromedial to the sensory root. The sensory root may be compressed by the superior cerebellar , anterior inferior cerebellar, or pontine branches of basilar artery which may be important in trigeminal neuralgia (11,12).…”

Section: Functional Components Of Mandibular Nerve and Their Intraneumentioning

confidence: 99%

Anatomy and clinical applications of the mandibular nerve

Somayaji¹,

Acharya²,

Mohandas³

et al. 2012

BLL

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Abstract:A thorough anatomical knowledge is very essential for clinical practice and any surgical procedure. Unfortunately anatomical variations can lead to hazards in medical and dental diagnosis and treatment. Such knowledge is very essential even in effective local anesthesia which is an essential part of treatment in patients with many oral disorders. Therefore a normal anatomy and its possible variations are utmost important aspects also in dentistry. One of the structures that dentists very often deal with is the mandibular nerve which therefore needs a thorough review. However, there are not many consolidated literature reviews available regarding its variations and clinical applications. Keeping this in mind, in this article, the authors have brought together available literature on various aspects of mandibular nerve. The fi nal review will be of benefi t to clinicians (Fig. 2 A thorough anatomical knowledge is very essential for clinical practice and any surgical procedure. The idea of exact location of various structures in the body prepares the clinician for a better approach in diagnosis and intervention. Unfortunately, the anatomical variations can lead to hazards in medical and dental diagnosis and treatment. Such knowledge is very essential even in effective local anesthesia which is an essential part of treatment in patients with many oral disorders. Therefore a normal anatomy and its possible variations are utmost important aspects also in dentistry. One of the structures that dentists very often deal with is the mandibular nerve which therefore needs a thorough review. However, there are not many consolidated literature reviews available regarding its variations and clinical applications. Keeping this in mind, in this article, the authors have brought together literature available on various aspects of mandibular nerve. The fi nal review will be of benefi t to clinicians.The mandibular nerve, largest division of trigeminal nerve, supplies the mandibular teeth and gums, mucosa of the anterior two thirds of the tongue, fl oor of the oral cavity, skin of the temporal region, part of the auricle and external acoustic meatus including the tympanum, lower lip, and lower and posterior parts of the face. Developmentally, it is the post-trematic nerve of the fi rst pharyngeal arch and therefore contains the motor fi bers to the muscles developed from the fi rst pharyngeal arch. It is a mixed nerve formed by the union of a large sensory root, branch of the lower part of the trigeminal ganglion and a smaller motor root from the pons which courses under the trigeminal ganglion. Both roots exit through the foramen ovale and unite just outside the foramen to form the trunk of the mandibular nerve which descends between the tensor veli palatini and lateral pterygoid muscles, gives off a meningeal branch and the nerve to medial pterygoid branch and ends by dividing into a smaller, mostly motor anterior branch and a larger, mostly sensory posterior branch. It contains about 78,000 myelinated fi bers. The nerve...

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Microvascular Relations of the Trigeminal Nerve: An Anatomical Study

Cited by 58 publications

References 0 publications

Trigeminal neuralgia caused by a trigeminocerebellar artery

Trigeminal neuralgia caused by a trigeminocerebellar artery

Trigeminal neuralgia caused by aneurysm of the posterior cerebral artery: a case description and the analysis of anatomical variety of vascular complex in the rood entry zone of trigeminal nerve

Anatomy and clinical applications of the mandibular nerve

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