High-resolution Three-dimensional Magnetic Resonance Angiography and Three-dimensional Spoiled Gradient-recalled Imaging in the Evaluation of Neurovascular Compression in Patients with Trigeminal Neuralgia: A Double-blind Pilot Study

Anderson, Valerie C.; Berryhill, Phillip; Sandquist, Michael A.; Ciaverella, David P.; Nesbit, Gary M.; Burchiel, Kim J.

doi:10.1227/01.neu.0000197117.34888.de

Cited by 151 publications

(112 citation statements)

References 15 publications

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“…A review of the literature reveals that a wide range (4%-89%) of TN patients has no demonstrable vascular contact. [2][3][4]12,19,24,26,34 For example, Leal et al 26 reported no NVC in 9% of patients by surgical exploration, and imaging revealed no vessel in relation to the nerve in 12% of patients. There are also reports in which all patients have NVC.…”

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confidence: 99%

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Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression

Lee¹,

McCartney²,

Burbidge³

et al. 2014

JNS

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118

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Object Vascular compression of the trigeminal nerve is the most common factor associated with the etiology of trigeminal neuralgia (TN). Microvascular decompression (MVD) has proven to be the most successful and durable surgical approach for this disorder. However, not all patients with TN manifest unequivocal neurovascular compression (NVC). Furthermore, over time patients with an initially successful MVD manifest a relentless rate of TN recurrence. Methods The authors performed a retrospective review of cases of TN Type 1 (TN1) or Type 2 (TN2) involving patients 18 years or older who underwent evaluation (and surgery when indicated) at Oregon Health & Science University between July 2006 and February 2013. Surgical and imaging findings were correlated. Results The review identified a total of 257 patients with TN (219 with TN1 and 38 with TN2) who underwent high-resolution MRI and MR angiography with 3D reconstruction of combined images using OsiriX. Imaging data revealed that the occurrence of TN1 and TN2 without NVC was 28.8% and 18.4%, respectively. A subgroup of 184 patients underwent surgical exploration. Imaging findings were highly correlated with surgical findings, with a sensitivity of 96% for TN1 and TN2 and a specificity of 90% for TN1 and 66% for TN2. Conclusions Magnetic resonance imaging detects NVC with a high degree of sensitivity. However, despite a diagnosis of TN1 or TN2, a significant number of patients have no NVC. Trigeminal neuralgia clearly occurs and recurs in the absence of NVC.

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confidence: 99%

“…Second, despite initially effective MVD, there is a steady rate of pain recurrence, which averages 4%-5% per year. [2][3][4]12,19,24,26,34 There is no consensus as to the etiology of pain recurrence in these cases.…”

mentioning

confidence: 99%

Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression

Lee¹,

McCartney²,

Burbidge³

et al. 2014

JNS

Self Cite

118

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“…[3][4][5][6][7][8][9][10][11][12] Symptomatic NVC is often found at the affected trigeminal nerve, but asymptomatic NVC is also detected at the contralateral and normal trigeminal nerves. 3,4,6 Regarding the MR imaging findings of the NVC, it remains to be clarified whether the NVC by an artery or a vein at the trigeminal nerve root entry zone causes TN.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Recent advances in MR imaging have provided us with fine volumetric data regarding the anatomic elements composing the NVC. [3][4][5][6][7][8][9][10][11][12] NVC is often detected on the affected side of TN (affected trigeminal nerve), though it is not infrequently observed in the asymptomatic nerve contralateral to the affected side (contralateral trigeminal nerve), as well as in the normal trigeminal nerve in a control subject without TN (normal trigeminal nerve). 3,4,6 The significance of the MR imaging findings of the NVC has not been established, and it remains unclear whether the NVC is symptomatic and linked to cause TN or asymptomatic and observed incidentally.…”

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confidence: 99%

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

Satoh¹,

Omi²,

Nabeshima³

et al. 2008

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Neurovascular contact (NVC) of the trigeminal nerve is not only detected at the affected trigeminal nerve in patients with trigeminal neuralgia (TN) but is also observed at the asymptomatic nerves on the side contralateral to the TN as well as in normal nerves in control subjects. The frequency and severity of the NVC among the affected, contralateral, and normal trigeminal nerves were analyzed by 3D MR cisternogram and angiogram fusion imaging in relation to the cause of TN.

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“…Although vast majority are idiopathic, possible symptomatic etiologies include aneurysms, tumors, chronic meningeal inflammation, or other lesions such as abnormal vascular course of the superior cerebellar artery, primitive trigeminal artery, venous compression, an area of demyelination from multiple sclerosis or lesions in the pons at the root entry zone (REZ) of the trigeminal fibers, symptomatic intracranial hypotension, among others [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Low saturated fat diet is effective in trigeminal neuralgia

Verma¹,

Sherwood²

2013

OJPM

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Objective: To determine the effectiveness of low saturated fat diet (LSFD) in patients with trigeminal neuralgia (TN). Design: 1) Internet forum where patients could request a 10 page LSFD plan, and 2) Follow-up assessment done by a retrospective 20-item questionnaire. Duration of treatment-2 months to 13 years. Pain rated on a Visual Analogue Scale and reported as typical, atypical, or both, defining typical TN as intermittent quick jolts/stabbing pain and atypical TN as continuous never ending discomfort. Setting: General community. Patients: 55 unselected patients, most with unilateral, severe and daily symptoms in V2 and V3 distribution for a mean duration of 8 years and on medications. 84% had pain level 9 -10 before treatment, 89% had daily attacks and 31% had undergone surgical procedures. Intervention: LSFD for 2 months-13 years (mean 20 months). Main outcome measure: VAS score and medication use before and after LSFD treatment. Results: Reported SF content was 3 -25 gm. With treatment 96% typical TN (p < 0.0001) and 71% atypical TN (p < 0.002) improved to level 0% -2. 9% improved in less than a week, 47% in 1 -2 weeks and 44% in 3 -4 weeks. 66% rated their compliance with diet as excellent and 27% as good. There were no side effects except weight loss. 72% of those on medications reduced or discontinued them. All patients with post-surgical residual severe typical TN also improved (p < 0.0001). Conclusions: LSFD is effective in TN with high compliance, few adverse effects and may result in reduction/ elimination of medications even in most severe cases.

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High-resolution Three-dimensional Magnetic Resonance Angiography and Three-dimensional Spoiled Gradient-recalled Imaging in the Evaluation of Neurovascular Compression in Patients with Trigeminal Neuralgia: A Double-blind Pilot Study

Cited by 151 publications

References 15 publications

Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression

Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression

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

Low saturated fat diet is effective in trigeminal neuralgia

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