Severity Analysis of Neurovascular Contact in Patients with Trigeminal Neuralgia: Assessment with the Inner View of the 3D MR Cisternogram and Angiogram Fusion Imaging

Satoh, Toru; Omi, Megumi; Nabeshima, M.; Onoda, Keisuke; Date, Isao

doi:10.3174/ajnr.a1409

Cited by 41 publications

(27 citation statements)

References 13 publications

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“…Preoperative visualization of the neurovascular relationship for microvascular decompression now allows both preoperative evaluation and the virtual reality for operative simulation. 5,6,13 Our preoperative neuroimaging studies do not include 3D fusion imaging in every patient with trigeminal neuralgia if typical vascular contact is observed on gradient echo imaging and MR angiography. In the present case, further 3D fusion images were obtained because how and which arteries from the distal part of the BA conflicted with the nerve root remained unclear.…”

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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“…9,14,15 Alternatives to standard MR cisternography (ie, image fusion between 3D CTA or 3D TOF-MRA and 3D MR cisternography) have been used to increase the contrast between vessels and cranial nerves. [19][20][21][22][23] However, several disadvantages of such image fusion techniques have been reported. First, some data may be lost through the segmentation process so that a signal defect in vessels or nerves occurs.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 On 3D TOF-MRA 8,[16][17][18] or 3D gadolinium-enhanced T1WI, 8,13,18 vessels are clearly depicted but the nerves are too poorly seen to be depicted at the point of NVC. Fused images of 3D CTA or 3D TOF-MRA and 3D MR cisternography have been used to evaluate the NVC to solve this problem, [19][20][21][22][23] but making these fusion images is technically challenging and too time-consuming for daily clinical practice.…”

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confidence: 99%

Usefulness of Subtraction of 3D T2WI-DRIVE from Contrast-Enhanced 3D T1WI: Preoperative Evaluations of the Neurovascular Anatomy of Patients with Neurovascular Compression Syndrome

Masuda¹,

Yamamoto²,

Akutsu³

et al. 2014

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:High-resolution 3D MR cisternography techniques such as 3D T2WI-driven equilibrium radiofrequency reset pulse (DRIVE) are used preoperatively to assess neurovascular anatomy in patients with neurovascular compression syndrome, but contrast between vessels and cranial nerves at the point of neurovascular contact is limited. The postprocessing technique subtraction of 3D T2WI-driven equilibrium radiofrequency reset pulse from contrast-enhanced 3D T1WI (sDRICE) provides both high spatial resolution and excellent contrast in depicting the neurovascular contact. We evaluated the usefulness of sDRICE compared with 3D T2WI-DRIVE.

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“…In order to overcome problems related to imaging artifacts, previous work has suggested considering vascular information from MR angiography (MRA) as additional source of information [1,3,23,26]. Based on the fusion of MRA and MR-CISS/FSE resulting in an optimized single dataset, advanced visualization [9] and a semi-automatic severity analysis [24] were achieved. The rendering quality was further improved with volume splatting and 2D transfer functions [29].…”

Section: Introductionmentioning

confidence: 99%