These findings indicate a clear difference between neurovascular contact and conflict and point to the use of high-resolution computed tomography visualization of the position of SCA loop apex relative to the trigeminal nerve root as a primary diagnostic method.
The thematic review discusses various points of view on the topographic and atomic features of the location of the root of the trigeminal nerve and the superior cerebellar artery that serve as the foundation for the development of classical trigeminal neuralgia. The diagnostic capabilities of magnetic resonance imaging in the recognition of neurovascular conflict as the pathogenetic basis of the disease are considered. The search for diagnostic criteria that distinguish neurovascular conflict from neurovascular contact by improving both the performance of MRI and the new technical possibilities of its interpretation is highlighted in the chronological aspect. The possibilities of multispiral X-ray computed angiography in 3D mode as an alternative method for diagnosing neurovascular conflict are described.
Objective: to study the formation of neurovascular conflicts of two types in patients with classical trigeminal neuralgia, depending on the influence of the environment of the Rostov region.Materials and methods: a retrospective study of the features of neurovascular conflict was conducted in 175 patients from the Rostov region who suffered from classical trigeminal neuralgia. The diagnosis of a variant of neurovascular conflict was carried out using spiral computed tomography on the device «Philips Ingenuity Core 128» The variant of neurovascular conflict was verified intraoperatively, when performing microvascular decompression of the trigeminal nerve root.Results: neurovascular conflict, both of the first and second types, occurs twice as often in women as in men. The development of the adhesive process in the zone of neurovascular conflict, which brings the root even closer to the artery that injures it, is due to the duration of the pathological process, during which inflammatory diseases of the paranasal sinuses, carious teeth, persistent herpesvirus infection play a significant role.Conclusions: variants of the syntopia of the trigeminal nerve root with the superior cerebellar artery in neurovascular conflict do not depend on environmental factors, and the frequency of occurrence of one type or another, as well as the gender ratio, correspond to the population.
Introduction. MRI is well-recognized as a leading method of neurovascular conflict (NVC) evaluation in patients with classical trigeminal neuralgia (CTN). NVC is regarded as the cause of the development of deformity, atrophy, or dislocation of the trigeminal nerve root. Currently, the number of worldwide publications concerning the analysis of NVC 3D-reconstruction for the diagnosis of cranial nerve hyperfunction syndromes is still small. The aim of the study was to evaluate the efficacy of NVC 3D-visualization for CTN diagnosis compared to conventional examination protocols. Materials and methods. From 2018 to 2020, 30 patients with CTN who underwent 3D-visualization of the NVC as a preoperative examination were involved in prospective nonrandomized study. T-2 3D (FIESTA), 3D-TOF and T1 FRSGR were utilized for 3D rendering (Fusion protocol). The obtained data were compared only FIESTA-based «prediction» of NVC and with intraoperative findings. Results. FIESTA-only prediction was effective in 93 %, and Fusion protocol — in 97 % of arterial type of NVC cases. Fusion protocol showed its supremacy in detecting venous type of compression. Average efficacy of FIESTA-only prediction was 84 %, whereas Fusion protocol showed 97 % correlation with intraoperative findings. Conclusion. Fusion protocol allows fast detection of NVC, its type and localization (not only at the REZ of the fifth nerve but also at its cisternal portion). It makes possible tracing the course of the compressing vessel and assess the «convenience» of decompressing the TN root, taking into account the spatial relationship of the brainstem, vessels of the cerebellopontine angle and cranial nerves. Unlike FIESTA-only scanning, 3D-rendering also offers a possibility of preoperative simulation of microvascular decompression by recreating intraoperative view with precise details. Patient examination with FIESTA-only scanning is inferior to the «extended» algorithm for NVC diagnosis and does not have these capabilities.
Цель: разработать достоверные критерии диагностики нейроваскулярого конфликта-патогенетической основы классической невралгии тройничного нерва (НТН). Материалы и методы: обследовано 25 больных классической НТН. Мультиспиральная рентген-компьютерная ангиография в режиме 3D обеспечивает идентификацию двух типов нейроваскулярного конфликта (НВК). Электроэнцефалография выполнена до и после устранения НВК. Результаты: первый тип НВК выявлен только у больных НТН. Второй тип с одинаковой частотой встречался как у больных НТН, так и у здоровых лиц. Динамика биоэлектрической активности головного мозга до и после устранения НВК позволила установить достоверные признаки изменений, характерные для НВК. Заключение: выявление у больного первого или второго типа конфликта и типичных для классической НТН изменений биоэлектрической активности головного мозга (формирование эпилептиформного очага, очагов ирритации в продолговатом мозге, превышение мощности электрической активности) позволяет отличить нейроваскулярный контакт от НВК. Ключевые слова: классическая невралгия тройничного нерва, нейроваскулярный конфликт.
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