The MRI volumetry of the posterior fossa and its substructures in trigeminal neuralgia: a validated study

Hořínek, Daniel; Brezova, Veronika; Nimsky, Christopher; Belšán, T.; Martinkovič, Lukáš; Masopust, Václav; Vrána, J.; Kozler, Petr; Plas, Jaroslav; Krýsl, David; Varjassyová, Alexandra; Ghaly, Youssef; Beneš, Vladimı́r

doi:10.1007/s00701-009-0283-8

Cited by 40 publications

(36 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These results, obtained via an imaging protocol and confirmed by two blinded observers, agreed with observations made during surgery, 8,20 pathological examination of specimens collected during surgery and showing axonal loss and extensive demyelination, 4,10,12,18 and studies whose authors measured V and CSA using various noninvasive imaging methods. 5,11,13 Interobserver agreement was 0.7559 for measurements of V and 0.9024 for measurement of CSA (p < 0.01).…”

Section: Diagnostic Value Of Anatomical Tgn Parametersmentioning

confidence: 90%

“…5,6,11,13,17 In 2005, Kress et al 13 measured V in 62 patients (41 with TN, including 6 patients with multiple sclerosis) with one investigator using 1.5-T MRI in 50 normal subjects. In that study, the mean V on the ipsilateralTN was 69.6 mm 3 (95% CI 37.2-110.6) and that on the contralateralTN was 84.5 mm 3 (95% CI 50.3-141.1).…”

Section: Diagnostic Value Of Anatomical Tgn Parametersmentioning

confidence: 99%

“…Recently, some authors 5,11,13 showed that in patients with TN, the affected TGN has a smaller volume (V) and cross-sectional area (CSA) than the unaffected nerve. Some works have established the notion that the outcome of microvascular decompression (MVD) depends on the severity of the NVC.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

Leal¹,

Barbier

Hermier

et al. 2014

JNS

108

View full text Add to dashboard Cite

S trong evidence suggests that in classic trigeminal neuralgia (TN) caused by neurovascular compression (NVC), the neuralgia is related to morphological and structural changes in the trigeminal nerve (TGN) that are probably the result of chronic vascular compression. Morphological changes in the nerve include nerve deviation, distortion, groove formation, and atrophy. 5 Atrophy of the nerve is seen in most cases of TN 20 and is probably attributable to structural abnormalities such as axonal loss and demyelination, 4,10,12,18 but these morphological changes are difficult to describe objectively. Object. The aim of this study was to prospectively evaluate atrophic changes in trigeminal nerves (TGNs) using measurements of volume (V) and cross-sectional area (CSA) from high-resolution 3-T MR images obtained in patients with unilateral trigeminal neuralgia (TN), and to correlate these data with patient and neurovascular compression (NVC) characteristics and with clinical outcomes.Methods. Anatomical TGN parameters (V and CSA) were obtained in 50 patients (30 women and 20 men; mean age 56.42 years, range 22-79 years) with classic TN before treatment with microvascular decompression (MVD). Parameters were compared between the symptomatic (ipsilateralTN) and asymptomatic (contralateralTN) sides of the face. Twenty normal control subjects were also included. Two independent observers blinded to the side of pain separately analyzed the images. Measurements of V (from the pons to the entrance of the nerve into Meckel's cave) and CSA (at 5 mm from the entry of the TGN into the pons) for each TGN were performed using imaging software and axial and coronal projections, respectively. These data were correlated with patient characteristics (age, duration of symptoms before MVD, side of pain, sex, and area of pain distribution), NVC characteristics (type of vessel involved in NVC, location of compression along the nerve, site of compression around the circumference of the root, and degree of compression), and clinical outcomes at the 2-year follow-up after surgery. Comparisons were made using Bonferroni's test. Interobserver variability was assessed using the Pearson correlation coefficient.Results. The mean V of the TGN on the ipsilateralTN (60.35 ± 21.74 mm 3 ) was significantly smaller (p < 0.05) than those for the contralateralTN and controls (78.62 ± 24.62 mm 3 and 89.09 ± 14.72 mm 3 , respectively). The mean CSA of the TGN on the ipsilateralTN (4.17 ± 1.74 mm 2 ) was significantly smaller than those for the contralateralTN and controls (5.41 ± 1.89 mm 2 and 5.64 ± 0.85 mm 2 , respectively). The ipsilateralTN with NVC Grade III (marked indentation) had a significantly smaller mean V than the ipsilateralTN with NVC Grade I (mere contact), although it was not significantly smaller than that of the ipsilateralTN with NVC Grade II (displacement or distortion of root). The ipsilateralTN with NVC Grade III had a significantly smaller mean CSA than the ipsilateralTN with NVC Grades I and II (p < 0.05). The TGN on the ipsilateralT...

show abstract

Section: Diagnostic Value Of Anatomical Tgn Parametersmentioning

confidence: 90%

Section: Diagnostic Value Of Anatomical Tgn Parametersmentioning

confidence: 99%

See 1 more Smart Citation

Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

Leal¹,

Barbier

Hermier

et al. 2014

JNS

108

View full text Add to dashboard Cite

show abstract

“…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.…”

mentioning

confidence: 99%

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

Duan

Sweet

Munyon

et al. 2015

JNS

View full text Add to dashboard Cite

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.

show abstract

“…29,38-41 Erbay et al 39 found that the nerve diameter and cross-sectional area were 20% and 28% smaller on the symptomatic side compared with the asymptomatic side. Horínek et al 40 found that the volume of the affected nerve was, on average, 28% smaller than that of the unaffected nerve; however, only 7 of the 18 patients with TN were diagnosed with nerve atrophy on the basis of MR imaging volumetry. Although CN V atrophy can be observed in TN, the low sensitivity of this finding does not warrant its routine use for the diagnosis of trigeminal NVCS.…”

mentioning

confidence: 99%

Imaging of Neurovascular Compression Syndromes: Trigeminal Neuralgia, Hemifacial Spasm, Vestibular Paroxysmia, and Glossopharyngeal Neuralgia

Haller

Etienne

Kovari

et al. 2016

American Journal of Neuroradiology

196

100

View full text Add to dashboard Cite

SUMMARY: Neurovascular compression syndromes are usually caused by arteries that directly contact the cisternal portion of a cranial nerve. Not all cases of neurovascular contact are clinically symptomatic. The transition zone between the central and peripheral myelin is the most vulnerable region for symptomatic neurovascular compression syndromes. Trigeminal neuralgia (cranial nerve V) has an incidence of 4 -20/100,000, a transition zone of 4 mm, with symptomatic neurovascular compression typically proximal. Hemifacial spasm (cranial nerve VII) has an incidence of 1/100,000, a transition zone of 2.5 mm, with symptomatic neurovascular compression typically proximal. Vestibular paroxysmia (cranial nerve VIII) has an unknown incidence, a transition zone of 11 mm, with symptomatic neurovascular compression typically at the internal auditory canal. Glossopharyngeal neuralgia (cranial nerve IX) has an incidence of 0.5/100,000, a transition zone of 1.5 mm, with symptomatic neurovascular compression typically proximal. The transition zone overlaps the root entry zone close to the brain stem in cranial nerves V, VII, and IX, yet it is more distal and does not overlap the root entry zone in cranial nerve VIII. Although symptomatic neurovascular compression syndromes may also occur if the neurovascular contact is outside the transition zone, symptomatic neurovascular compression syndromes are more common if the neurovascular contact occurs at the transition zone or central myelin section, in particular when associated with nerve displacement and atrophy. ABBREVIATIONS:AICA ϭ anterior inferior cerebellar artery; CN ϭ cranial nerve; GN ϭ glossopharyngeal neuralgia; HFS ϭ hemifacial spasm; NVC ϭ neurovascular

show abstract

The MRI volumetry of the posterior fossa and its substructures in trigeminal neuralgia: a validated study

Abstract: We did not find any association between the clinical neurovascular conflict (NVC) and the size of the posterior fossa and its substructures. MRI volumetry may show the atrophy of the affected trigeminal nerve in clinical NVC.

Cited by 40 publications

References 18 publications

Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

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

Imaging of Neurovascular Compression Syndromes: Trigeminal Neuralgia, Hemifacial Spasm, Vestibular Paroxysmia, and Glossopharyngeal Neuralgia

Contact Info

Product

Resources

About