Radiographic evaluation of trigeminal neurovascular compression in patients with and without trigeminal neuralgia

Miller, Jonathan P.; Acar, Feri̇dun; Hamilton, Bronwyn E.; Burchiel, Kim J.

doi:10.3171/2008.6.17620

Cited by 126 publications

(87 citation statements)

References 34 publications

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“…However, analysis of anatomical and clinical data supports our concept that at the level of the brainstem, when leaving the trigeminal root, specifically at the REZ, the sensory fibers change their direction to target their proper nuclei in the trigeminal brainstem nuclear sensory complex (TBNSC) (Crissman et al, 1996;Pajot et al, 2000;Devor et al, 2002b;Sindou et al, 2002Sindou et al, , 2006Miller et al, 2009). Consequently, many of the Aβ fibers transmitting tactile information from the orofacial region leave the trigeminal root rostrally in their trajectory to the main sensory nucleus, located at the level of the midpons (Samii and Jannetta, 1981;Sessle, 2000) (Fig.…”

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confidence: 94%

The Role of Sensory Fiber Demography in Trigeminal and Postherpetic Neuralgias

DaSilva

DosSantos

2011

J Dent Res

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A supplemental appendix to this article is published electronically only at http://jdr.sagepub.com/supplemental. AbstrActIn this study, we systematically investigated fiber demography, based on function and distribution, from the periphery to their destinations in the various central (sub) nuclei in the trigeminal brainstem nuclear sensory complex. Conventional and novel compelling information is provided, demonstrating that the ratio and somatotopy of types A and C sensory fibers at the site of a lesion can elucidate important puzzles in TNP disorders. For instance, we explain how of a major shift in the fibers' direction and ratio at the level of the trigeminal root entry zone (REZ) influences the pathophysiology of preand typical trigeminal neuralgia. As a result, there is a high A/C ratio of oral and peri-oral fibers in the supero-medial region of the REZ, which is mostly susceptible to vascular compression. However, this A/C ratio varies considerably at lower proportions in other areas along the peripheral trigeminal pathway, where an injury (viral, vessel compression, or trauma) can lead to a broader spectrum of fiber involvement and, consequently, pain outcome. In summary, we explain how fiber demography can influence pain quality, location, temporal features, progress, and treatment prognosis of TNP in those patients who develop it.

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confidence: 94%

The Role of Sensory Fiber Demography in Trigeminal and Postherpetic Neuralgias

DaSilva

DosSantos

2011

J Dent Res

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“…Magnetic resonance imaging (BFFE and MRA) using a 3-T MR scanner (Philips Achieva) was performed as previously described. 34,35 The 3D reconstructions were independently reviewed by a neurosurgical fellow blinded to the surgical findings.…”

Section: Imagingmentioning

confidence: 99%

“…We have previously demonstrated that 17% of the general population manifests NVC of the trigeminal nerve. 35 If, as has been estimated, the incidence of TN in the population is 1:10,000 (0.01%), 32 then 99.94% of individuals with trigeminal NVC do not have TN. Given these statistics, and the present evidence that TN can both occur and recur without NVC, the hypothesis that TN is caused by neurovascular conflict must be challenged.…”

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confidence: 99%

“…1 A review of autopsy studies reveals some degree of contact between the trigeminal nerve and a blood vessel in 90%-100% of patients with TN, but also in 16%-58% of patients without TN. [16][17][18][19] In 2009, Miller et al, 35 evaluated neurovascular compression (NVC) in patients with and without TN and concluded that trigeminal NVC occurred in asymptomatic patients but was more severe and more proximal in patients with TN. A review of the literature reveals that a wide range (4%-89%) of TN patients has no demonstrable vascular contact.…”

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confidence: 99%

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Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression

Lee¹,

McCartney²,

Burbidge³

et al. 2014

JNS

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Object Vascular compression of the trigeminal nerve is the most common factor associated with the etiology of trigeminal neuralgia (TN). Microvascular decompression (MVD) has proven to be the most successful and durable surgical approach for this disorder. However, not all patients with TN manifest unequivocal neurovascular compression (NVC). Furthermore, over time patients with an initially successful MVD manifest a relentless rate of TN recurrence. Methods The authors performed a retrospective review of cases of TN Type 1 (TN1) or Type 2 (TN2) involving patients 18 years or older who underwent evaluation (and surgery when indicated) at Oregon Health & Science University between July 2006 and February 2013. Surgical and imaging findings were correlated. Results The review identified a total of 257 patients with TN (219 with TN1 and 38 with TN2) who underwent high-resolution MRI and MR angiography with 3D reconstruction of combined images using OsiriX. Imaging data revealed that the occurrence of TN1 and TN2 without NVC was 28.8% and 18.4%, respectively. A subgroup of 184 patients underwent surgical exploration. Imaging findings were highly correlated with surgical findings, with a sensitivity of 96% for TN1 and TN2 and a specificity of 90% for TN1 and 66% for TN2. Conclusions Magnetic resonance imaging detects NVC with a high degree of sensitivity. However, despite a diagnosis of TN1 or TN2, a significant number of patients have no NVC. Trigeminal neuralgia clearly occurs and recurs in the absence of NVC.

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“…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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Radiographic evaluation of trigeminal neurovascular compression in patients with and without trigeminal neuralgia

Abstract: Trigeminal NVC occurs in asymptomatic patients but is more severe and more proximal in patients with TN. This information may help identify patients who are likely to benefit from microvascular decompression.

Cited by 126 publications

References 34 publications

The Role of Sensory Fiber Demography in Trigeminal and Postherpetic Neuralgias

The Role of Sensory Fiber Demography in Trigeminal and Postherpetic Neuralgias

Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression

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

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