Magnetic resonance tomographic angiography: diagnostic value in trigeminal neuralgia

Abstract

A combination of MRI, MR angiography and MR tomographic angiography (MRTA) was used to study the relationship of the root exit zone of the trigeminal nerve to surrounding vascular structures in seven patients with trigeminal neuralgia (TN) and ten patients with no evidence at a lesion in this region. MRTA is the technique for showing the relationship between vessels, cranial nerves and brain stem. MRTA clearly demonstrated the presence of a vessel at the root exit zone of the trigeminal nerve in all patients with TN. In the ten other patients, examination of 20 trigeminal nerves revealed that only one nerve (5%) was in contact with a vessel at the root exit zone. This study supports vascular compression of trigeminal nerves as a cause of TN, and demonstrates the value of MRTA as noninvasive technique for demonstrating compression.

Three-dimensional visualization of neurovascular relationships in the posterior fossa: technique and clinical application

“…There is great controversy about the imaging of neurovascular relationships at the surface of the brainstem, and the studies presented so far result in divergent conclusions, especially for the detection of neurovascular compression. 3,5,7,8,19,22,26,[31][32][33]37,45 This controversy resembles the discussion when Jannetta 21 introduced his concept of neurovascular compression as the cause of hyperactive cranial nerve dysfunction syndromes. It was difficult for Jannetta and other advocates of this hypothesis to convince the skeptics: 1 .…”

“…The majority of the studies conclude that MR imaging can be used to detect neurovascular compression in the classic compression syndromes like trigeminal neuralgia or hemifacial spasm. [3][4][5]7,25,44,45 Intraoperative photomicrographs and video documentation served as the basis for verifying the 3D visualization results. This comparison showed that our method is in fact able to demonstrate the relationships correctly (Figs.…”

“…3,4,7,10,18,20,26,28,31,40,44,45,47 Improvements in MR technology and progress in developing new MR imaging protocols like CISS resulting in strongly T 2 -weighted images 9 provide sufficiently high resolution below 1 mm, even between consecutive slices. 23,27,30,41,48 The imaging data demonstrate improved contrast between neighboring structures, allowing us to differentiate cranial nerves and vessels within the CSF at the surface of the brainstem.…”

Pathology of the Trigeminal Nerve

“…2,5,10 In classic TN, the superior cerebellar artery or one of its branches, the anterior inferior cerebellar artery, the PICA, or the basilar artery, usually compresses the root entry zone. 6,29,30 Rarely, the conflicting vessel is a petrous vein, a saccular aneurysm, a persistent trigeminal artery, or an AVM. 31,32 Recently, it has been shown that the size of the cerebellopontine cistern, as measured with MR imaging, may play a role in favoring a neurovascular conflict, because a significantly smaller volume of the cistern was found in patients who had TN on the affected side.…”

Substanz P, Somatostatin und monoaminerge Transmitter in der Zerebrospinalflüssigkeit von Patienten mit chronischer idiopathischer Trigeminusneuralgie

“…Neurotransmitter 9 Substanz P 9 Somatostatin Die Atiologie der Trigeminusneuralgie ist nach wie v0r unbekannt. Zahlreiche neuroradiologische [44], neuroanatomische [45,20] und neurochirurgische Befunde [31,39] legen eine periphere Genese des Schmerzes bei der Trigeminusneuralgie nahe. MOgliche Ursachen einer chronischen mechanischen Irritation der Trigeminuswurzel bestehen z.B.…”