High-resolution Diffusion Tensor Imaging for the Detection of Diffusion Abnormalities in the Trigeminal Nerves of Patients with Trigeminal Neuralgia Caused by Neurovascular Compression

Fujiwara, Shunrou; Sasaki, Makoto; Wada, Takeshi; Kudo, Kohsuke; Hirooka, Ryonoshin; Ishigaki, Daiya; Nishikawa, Yasumasa; Ono, Akio; Yamaguchi, Mai; Ogasawara, Kuniaki

doi:10.1111/j.1552-6569.2010.00508.x

Cited by 67 publications

(61 citation statements)

References 23 publications

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“…But also regarding the non-affected side of patients with NVC-related TN, FA was significantly decreased in patients compared to that in healthy controls in this investigation, whereas ADC values did not differ significantly. These findings are in line with previous studies, indicating that FA might be more sensitive and detect more subtle anisotropic nerve changes compared to ADC [10,30].…”

Section: Discussionsupporting

confidence: 94%

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

et al. 2014

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Section: Discussionsupporting

confidence: 94%

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

et al. 2014

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“…Histological analysis from typical-TN patients showed that compressed trigeminal root specimens had axonopathies and axonal loss that could induce ectopic after-discharge and cross-excitation of neighboring fibers (Devor et al, 2002a,b). Those axonopathies are also evidenced by recent studies with diffusion tensor imaging (DTI) that demonstrated microstructural changes in the trigeminal roots of patients with trigeminal neuralgia (Fujiwara et al, 2010;Lutz et al, 2011). Furthermore, focal demyelination was demonstrated exactly at the REZ in cases of trigeminal neuralgia due to multiple sclerosis (Love et al, 2001).…”

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confidence: 72%

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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“…9,10,23,27 Here, no significant correlation between ADC values and any of the clinical, anatomical, and intraoperative findings was seen. This also included patients with a more severe, Grade III neurovascular compression.…”

Section: Fa Analysis But Not Adc Identifies Structural Alterationsmentioning

confidence: 90%

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

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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...

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High-resolution Diffusion Tensor Imaging for the Detection of Diffusion Abnormalities in the Trigeminal Nerves of Patients with Trigeminal Neuralgia Caused by Neurovascular Compression

Abstract: HR-DTI can detect an alteration in the relative FA values of affected trigeminal nerves and a correlation with atrophic changes in patients with NVC-induced TN.

Cited by 67 publications

References 23 publications

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

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

The Role of Sensory Fiber Demography in Trigeminal and Postherpetic Neuralgias

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

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