Patients with idiopathic trigeminal neuralgia have a sharper-than-normal trigeminal-pontine angle and trigeminal nerve atrophy

Ha, Seung Man; Kim, Sang Heum; Yoo, Eun Sun; Han, In Ho; Shin, Dong Ah; Cho, Kyung Gi; Chung, Sang Sup; Park, Young Seok

doi:10.1007/s00701-012-1327-z

Cited by 32 publications

(19 citation statements)

References 26 publications

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“…Numerous studies have assessed the pattern of neurovascular conflict (NVC) due to crowding of the cisternal space and the neurovascular structures that occupy that space and its association with symptoms of TN. 5,7,17,18 Park and colleagues retrospectively reviewed MRI studies of 26 patients with unilateral TN treated with Gamma Knife radiosurgery. 17 They found a significantly smaller crosssectional area in the cerebellar-pontine angle cistern in the symptomatic side compared with the asymptomatic side, as well as a shorter cisternal segment of the trigeminal nerve on the affected side.…”

Section: Discussionmentioning

confidence: 99%

“…4,5,7,9,10,17 In a retrospective study of 30 patients with idiopathic TN, Ha and colleagues demonstrated that, on preoperative FIESTA MRI, there was significantly more atrophy at the cisternal segment of the trigeminal nerve on the affected side than on the unaffected side compared with the affected and unaffected sides of age-and sexmatched control patients with hemifacial spasm. 5 Of note, these authors also found a significant association between the sharpness of the trigeminal-pontine angle on the affected side compared with the unaffected side, which was not found in the control group. Likewise, a study by Erbay and colleagues looked at using MRI studies obtained in 36 patients with unilateral TN treated with Gamma Knife radiosurgery.…”

Section: Discussionmentioning

confidence: 99%

“…8,10,13,21 Structural changes in the trigeminal nerve, leading to volume loss, have been well documented, 3,6,12 and a number of studies have demonstrated that nerve atrophy ipsilateral to the symptomatic side is visible on preoperative MRI. 1,4,5,7,9,15,17 Recently, Leal et al demonstrated that atrophy in the midcisternal region of the nerve is associated with more severe vascular compression, and these patients tend to exhibit greater clinical improvement following surgical decompression of the nerve. 10 However, it is unclear whether the nerve atrophy is entirely due to physical compaction by the compressing vessel or whether it is due, in part, to irreversible structural changes.…”

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

Duan

Sweet

Munyon

et al. 2015

JNS

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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

Duan

Sweet

Munyon

et al. 2015

JNS

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“…It has been reported that a sharp trigeminal pontine angle may be a useful additional diagnostic factor for idiopathic TN, facilitating the NVC (21,22).…”

Section: A B a Bmentioning

confidence: 99%

Can pontine trigeminal T2-hyperintensity suggest herpetic etiology of trigeminal neuralgia?

D’Amico

Russo

Ugga

et al. 2016

Quant. Imaging Med. Surg.

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Background: Trigeminal neuralgia (TN) is usually classified into two different categories: idiopathic and secondary. We have investigated the frequency of brainstem pontine lesions in patients with idiopathic TN without multiple sclerosis (MS) or stroke, and their association with herpes zoster (HZ) infection.Methods: Brain magnetic resonance imaging (MRI) studies of 28 patients with TN were retrospectively reviewed. Results:We found seven patients with clinical suspicion of HZ infection and pontine T2 hyperintense lesions, associated with nerve atrophy in one case. Fifteen patients had a neurovascular conflict (NVC) without brainstem involvement, two of them associated with trigeminal atrophy, while four patients had only volumetric reduction of the nerve. In all patients MRI findings were ipsilateral to the side of TN.Conclusions: Pontine T2 hyperintensities could be considered as a MRI sign of TN in patients without NVCs. This "trigeminal pontine sign" (TPS) is frequently found in association with herpetic infections. Methods MRI brain scans of twenty-eight patients (18F, 10M; mean age 52.8±14 years; range of age 26-80 years) with TN without MS or brainstem infarction were retrospectively reviewed by two neuroradiologists with 20 and 24 years of experience, respectively.Eighteen patients (12F, 6M; mean age 50 years; range of age 26-77 years) had idiopathic TN while ten patients (6F, 4M; mean age 50 years; range of age 34-63 years) had a clinical suspicion of a herpes zoster (HZ) infection; only four of these ten patients performed lumbar puncture that confirmed the diagnosis.In all cases a brain MRI was performed (Gyroscan Intera, 1.5 T, Philips Medical System, Best, The Netherlands), including FLAIR (TR: 8,005 ms, TE: 100 ms, TI: 2,200 ms, matrix: 256×192, slice thickness: 5 mm), Fast Spin-Echo (FSE) T1-and T2-weighted (TR: 583-4,454 ms, TE: 15-100 ms, matrix: 244×194−384×288, slice thickness: 5 mm, respectively) sequences; axial three-dimensional (3D) FSE T2 with a driven equilibrium pulse (DRIVE) sequence (TE: 250; TR: 1,500; flip angle: 90°; matrix: 256×256; slice thickness: 1×1×1 mm; FOV: 130×130) and magnetic resonance angiography (MRA) were performed to depict NVC and nerve atrophy. MRA was performed without contrast medium injection by using a 3-dimensional time-of-flight sequence (3D TOF, TE: 65 ms; TR: 6.9 ms; flip angle: 20°; matrix: 160×160; slice thickness: 1.40 mm; FOV: 175×200 mm). Multi planar reformation (MPR) and maximum intensity projection (MIP) reconstructions were subsequently analyzed.We evaluated the presence of brainstem lesions and their correlation with the side of the pain and the TN category. ResultsSeven patients with HZ infection showed hyperintense pontine areas on turbo spin echo (TSE) T2-weighted and FLAIR images, which we called "trigeminal pontine sign" (TPS), all of them without a NVC. Their data were summarized in Table 1. MRI was always consistent with the side of the pain. These lesions had a linear appearance, involving the pathway from the trigeminal root entry zone (...

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“…Large arteries are more likely to cause higher RD and more easily to make trigeminal nerve demyelination, while small arteries are not. Some studies [ 4 , 5 , 10 , 12 ] showed that trigeminal nerve demyelination is prevalent in TN patients. Demyelination causes destruction of the trigeminal nerve integrity, which leads to TN.…”

Section: Discussionmentioning

confidence: 99%

Large-diameter compression arteries as a possible facilitating factor for trigeminal neuralgia: analysis of axial and radial diffusivity

et al. 2016

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BackgroundNeurovascular compression (NVC) of the trigeminal nerve is associated with trigeminal neuralgia (TN). Some arteries that compress the trigeminal nerve are large, while others are small. This study evaluated the influence of diameter of compression arteries (DCA) on NVC with and without TN using axial diffusivity (AD) and radial diffusivity (RD) of magnetic resonance (MR) imaging.MethodsFifty TN patients with unilateral NVC, 50 asymptomatic patients with unilateral NVC, and 50 healthy controls (HC) were divided into three groups (NVC with TN, NVC without TN, and HC). The three groups were imaged with a 3.0-T MR system using three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) and diffusion tensor imaging (DTI). We compared the mean size of DCA between NVC with and without TN. The mean values of AD and RD at the site of NVC were compared between the three groups. Correlation analyses were performed between the DCA and the diffusion metrics (AD and RD) in NVC patients with and without TN.ResultsThe mean DCA in NVC patients with TN (1.58 ± 0.34 mm) was larger than that without TN (0.89 ± 0.29 mm). Compared with NVC without TN and HC, the mean values of RD at the site of NVC with TN were significantly increased; however, no significant changes of AD were found between the groups. Correlation analysis showed that DCA positively correlated with RD in NVC patients with and without TN (r = 0.830, p = 0.000). No significant correlation was found between DCA and AD (r = 0.178, p = 0.077).ConclusionsLarger-diameter compression arteries may increase the chances of TN, and may be a possible facilitating factor for TN.

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Patients with idiopathic trigeminal neuralgia have a sharper-than-normal trigeminal-pontine angle and trigeminal nerve atrophy

Abstract: A sharp trigeminal-pontine angle on the affected side was found in idiopathic TN patients by FIESTA imaging. This suggests that a sharp trigeminal-pontine angle increases the chance of neurovascular compression on the medial side of the trigeminal nerve.

Cited by 32 publications

References 26 publications

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

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

Can pontine trigeminal T2-hyperintensity suggest herpetic etiology of trigeminal neuralgia?

Large-diameter compression arteries as a possible facilitating factor for trigeminal neuralgia: analysis of axial and radial diffusivity

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