Diffusion tensor imaging of the trigeminal nerve in patients with trigeminal neuralgia due to multiple sclerosis

Lummel, Nina; Mehrkens, Jan H.; Linn, Jennifer; Buchholz, Grete; Stahl, Robert; Bochmann, Katja; Brückmann, H.; Lutz, Jürgen

doi:10.1007/s00234-014-1463-7

Cited by 42 publications

(40 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the current prospective evaluation of a large number of patients, a clear correlation between decreased FA values and symptomatic nerve compression was confirmed. Lower FA values were also seen on the symptomatic side in the 3 patients with negative MRI and in those 14 patients with an incidental finding of a neurovascular contact on the contralateral side; in this subpopulation, the FA values on the contralateral asymptomatic side matched the values that have been described for normal controls, 26 despite Grade I compression on MRI. The latter aspect is supported by Lin and colleagues who also found regular FA and ADC values in asymptomatic individuals with vascular compression of the trigeminal nerve.…”

Section: Dti Of Tn Due To Neurovascular Compressionsupporting

confidence: 69%

“…In line with our previous reports, 26,27 the ADC and FA values were prospectively defined as the primary parameters in the DTI analysis. Accurate measurement was ensured by the same neuroradiologist (J. Lutz) with profound experience using this technique.…”

Section: Analysis Of the Dti Data Setsmentioning

confidence: 85%

“…8,21,27 FA and ADC represent the 2 DTI indices that are most widely used because they reliably indicate abnormalities in white matter tracts, independent of their cause. 3,26,30 The measurement of FA provides robust values for quantifying the degree of directionality of diffusion (i.e., anisotropic diffusion) as a marker of microstructural integrity. It is generally believed that degeneration of the white matter tracts results in a reduction in FA, as well as in an increase in ADC values, due to diffusivity being averaged in all spatial directions as a result of the loss of myelin and axonal membranes.…”

Section: Dti Of Tn Due To Neurovascular Compressionmentioning

confidence: 99%

See 2 more Smart Citations

Microstructural alterations in trigeminal neuralgia determined by diffusion tensor imaging are independent of symptom duration, severity, and type of neurovascular conflict

Lutz¹,

Thon²,

Stahl³

et al. 2016

JNS

View full text Add to dashboard Cite

T rigeminal neuralgia (TN) is characterized by recurrent episodes of intense and lancinating pain localized to the sensory supply areas of the fifth cranial nerve (CN V), which is also known as the trigeminal nerve. 11 The most frequent cause of TN is mechanical irritation of the nerve within a vulnerable zone that extents for about 4 to 5 mm from the point of transition from the peripheral (derived from Schwann cells) to the central myelin (derived from the oligodendroglia) (i.e., transition zone) to the most proximal aspect, where the nerve enters the pons (i.e., root entry zone [REZ]). 24,25,31,32 It is widely believed that direct arterial contact causes pulsatile, repetitive trauma that leads to focal axonal degeneration and demyelination processes within this vulnerable site. 9,13,25 These structural alterations facilitate ephaptic neurotransmissions that cause pain upon common triggers such as chewing or tactile sensations.11 Most frequently, neurovascular compression is caused by a direct anatomical relation with the superior cerebellar artery (SCA) (60%-90%), followed by the anterior inferior cerebellar aBBreViatiONS AD = axial diffusivity; ADC = apparent diffusion coefficient; AICA = anterior inferior cerebellar artery; CE = contrast enhanced; CN = cranial nerve; DTI = diffusion tensor imaging; FA = fractional anisotropy; FIESTA = fast imaging employing steady-state acquisition; MRA = MR angiography; MVD = microsurgical decompression; PICA = posterior inferior cerebellar artery; RD = radial diffusivity; REZ = root entry zone; ROI = region of interest; SCA = superior cerebellar artery; TN = trigeminal neuralgia. OBJectiVe In this prospective study diffusion tensor imaging (DTI) was used to evaluate the influence of clinical and anatomical parameters on structural alterations within the fifth cranial nerve in patients with trigeminal neuralgia (TN) due to neurovascular compression. methOdS Overall, 81 patients (40 men and 41 women; mean age 60 ± 5 years) with typical TN were included who underwent microsurgical decompression. Preoperative 3.0-T high-resolution MRI and DTI were analyzed in a blinded fashion. The respective fractional anisotropy (FA) and apparent diffusion coefficient values were compared with the clinical, imaging, and intraoperative data. This study was approved by the institutional review board, and written informed consent was obtained from all patients. reSultS DTI analyses revealed significantly lower FA values within the vulnerable zone of the affected trigeminal nerve compared with the contralateral side (p = 0.05). The DTI analyses also included 3 patients without clear evidence of neurovascular conflict on preoperative MRI. No differences were seen between arterial and venous compression. Lower FA values were found 5 months after symptom onset; however, no correlation was found with the duration of symptoms or severity of compression. cONcluSiONS DTI analysis allows the quantification of structural alterations, even in those patients without any discernible neurovascular contact o...

show abstract

Section: Dti Of Tn Due To Neurovascular Compressionsupporting

confidence: 69%

Section: Analysis Of the Dti Data Setsmentioning

confidence: 85%

Section: Dti Of Tn Due To Neurovascular Compressionmentioning

confidence: 99%

See 1 more Smart Citation

Microstructural alterations in trigeminal neuralgia determined by diffusion tensor imaging are independent of symptom duration, severity, and type of neurovascular conflict

Lutz¹,

Thon²,

Stahl³

et al. 2016

JNS

View full text Add to dashboard Cite

show abstract

“…Conversely, patients with classical TGN had lower FA values only on the affected side, suggesting a difference in underlying pathogenesis of TGN between MS-related TGN and classical TGN. 28 When patients with TGN present with sensory loss in a CN V distribution, a possible mass arising along the course of CN V should be suspected. Schwannomas of CN V may occur at any point distal to the transition zone between central and peripheral myelination in CN V.c and can also be associated with TGN.…”

Section: Imaging Of Other Causes Of Trigeminal Neuralgiamentioning

confidence: 99%

The Role of Imaging for Trigeminal Neuralgia

Seeburg

Northcutt

Aygün

et al. 2016

Neurosurgery Clinics of North America

View full text Add to dashboard Cite

“…[2, 4] Possible etiologies of the disease include neurovascular compression (NVC) [5], multiple sclerosis [6], tumors [7], arteriovenous malformations [8], and facial injury. [9] The most commonly accepted etiology in TN is thought to be related to NVC [1] as originally described by Dr. Janetta.…”

Section: Introduction and Etiologymentioning

confidence: 99%

Is There a Magnetic Resonance Imaging-Discernible Cause for Trigeminal Neuralgia? A Structured Review

2017

View full text Add to dashboard Cite

Background Trigeminal neuralgia (TN) is a chronic brain condition involving the trigeminal nerve and characterized by severe and recurrent facial pain. While the etiology of TN has been researched extensively, there is a lack of convergence on the exact physiological processes leading to pain symptoms. This review seeks to better elucidate the underlying pathophysiology of TN by analyzing the outcomes of studies that utilize magnetic resonance (MR) structural imaging and diffusion-weighted imaging (DWI) to examine nerve damage in patients with TN. Methods Performing a structured review of the literature, the authors included human MR anatomical and DWI studies aimed at visualizing the trigeminal nerve and/or measuring neural damage pertaining to TN. Studies that measured and compared nerve damage in the affected and unaffected sides in patients and/or patients and controls were analyzed for neural changes associated with TN. Results Twenty-five studies met inclusion criteria. Overall, the data from the anatomical and diffusion studies showed decreased volume and cross sectional area, decreased fractional anisotropy, and increased apparent diffusion coefficient and diffusivity associated with the affected side of patients compared to the unaffected side as well as in patients compared to controls. Conclusion A review of the included studies indicates that neural differences exist between the affected and unaffected sides in patients as well as between patients and controls in both structural and diffusion metrics. The amalgamated data suggests that damage of the trigeminal nerve tissue is commonly found in TN patients and could be a primary factor in TN pathophysiology.

show abstract

Diffusion tensor imaging of the trigeminal nerve in patients with trigeminal neuralgia due to multiple sclerosis

Abstract: In patients with MS-related TN, DTI reveals microstructural changes within the trigeminal nerve not only on the affected side but also on the clinically non-affected side.

Cited by 42 publications

References 32 publications

Microstructural alterations in trigeminal neuralgia determined by diffusion tensor imaging are independent of symptom duration, severity, and type of neurovascular conflict

Microstructural alterations in trigeminal neuralgia determined by diffusion tensor imaging are independent of symptom duration, severity, and type of neurovascular conflict

The Role of Imaging for Trigeminal Neuralgia

Is There a Magnetic Resonance Imaging-Discernible Cause for Trigeminal Neuralgia? A Structured Review

Contact Info

Product

Resources

About