Neurovascular relationships in the posterior cranial fossa, with special reference to trigeminal neuralgia. 2. Neurovascular compression of the trigeminal nerve in cadaveric controls and patients with trigeminal neuralgia: Quantification and influence of method

Hamlyn, Peter J.

doi:10.1002/(sici)1098-2353(1997)10:6<380::aid-ca2>3.0.co;2-t

Cited by 82 publications

(44 citation statements)

References 18 publications

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“…TMD are characterized by throbbing, tender, continuous pain and result from or are initiated by activation of nociceptors in the temporomandibular joint and/or muscles of mastication (Sarlani and Greenspan, 2005;Ro, 2008;Sessle et al, 2008;Manfredini and Nardini, 2010). In contrast, trigeminal neuralgia is characterized by intermittent periods of sharp, electricity-like, shooting pain that results primarily from compression of the trigeminal root entry zone by an arterial vessel (Meaney et al, 1995;Hamlyn, 1997). Indeed, surgical interventions in which the offending artery is physically separated from the trigeminal nerve are successful at relieving this type of pain (Meaney et al, 1995;Leandri et al, 1998).…”

Section: Neuropathic Pain and The Thalamussupporting

confidence: 81%

Different Pain, Different Brain: Thalamic Anatomy in Neuropathic and Non-Neuropathic Chronic Pain Syndromes

Gustin¹,

Peck²,

Wilcox³

et al. 2011

J. Neurosci.

206

180

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Trigeminal neuropathic pain (TNP) and temporomandibular disorders (TMD) are thought to have fundamentally different etiologies. It has been proposed that TNP arises through damage to, or pressure on, somatosensory afferents in the trigeminal nerve, whereas TMD results primarily from peripheral nociceptor activation. Because some reports suggest that neuropathic pain is associated with changes in brain anatomy, it is possible that TNP is maintained by changes in higher brain structures, whereas TMD is not. The aim of this investigation is to determine whether changes in regional brain anatomy and biochemistry occur in both conditions. Twenty-one TNP subjects, 20 TMD subjects, and 36 healthy controls were recruited. Voxel-based morphometry of T1-weighted anatomical images revealed no significant regional gray matter volume change in TMD patients. In contrast, gray matter volume of TNP patients was reduced in the primary somatosensory cortex, anterior insula, putamen, nucleus accumbens, and the thalamus, whereas gray matter volume was increased in the posterior insula. The thalamic volume decrease was only seen in the TNP patients classified as having trigeminal neuropathy but not those with trigeminal neuralgia. Furthermore, in trigeminal neuropathy patients, magnetic resonance spectroscopy revealed a significant reduction in the N-acetylaspartate/creatine ratio, a biochemical marker of neural viability, in the region of thalamic volume loss. The data suggest that the pathogenesis underlying neuropathic and non-neuropathic pain conditions are fundamentally different and that neuropathic pain conditions that result from peripheral injuries may be generated and/or maintained by structural changes in regions such as the thalamus.

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Section: Neuropathic Pain and The Thalamussupporting

confidence: 81%

Different Pain, Different Brain: Thalamic Anatomy in Neuropathic and Non-Neuropathic Chronic Pain Syndromes

Gustin¹,

Peck²,

Wilcox³

et al. 2011

J. Neurosci.

206

180

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“…Since Dandy's report, authors of several studies have noted an increased rate of venous contact or compression in patients with TN as compared with rates in cadavers without a history of TN. 4,5 Trigeminal neuralgia, which is most often unilateral, can occur in any one or combination of the 3 branches of the trigeminal nerve. In order of frequency in the general population, TN occurs in the V2 and V3 distributions (30-36%), V2 distribution (10-22%), V1 and V2 distributions (17-22%), V3 distribution (15%), V1 and V2 and V3 distributions (8-12%), and V1 distribution (2-3%).…”

Section: Discussionmentioning

confidence: 96%

Microvascular decompression in patients with isolated maxillary division trigeminal neuralgia, with particular attention to venous pathology

Sekula

Frederickson²,

Jannetta³

et al. 2009

FOC

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Object The authors have the clinical impression that patients with isolated V2, or maxillary division, trigeminal neuralgia (TN) are most often women of a younger age with atypical pain features and a predominance of venous compression as the pathology. The aim of this study was to evaluate a specific subgroup of patients with V2 TN. Methods Among 120 patients who underwent microvascular decompression (MVD) for TN in 2007, data were available for 114; 6 patients were lost to follow-up. Patients were stratified according to typical (Burchiel Type 1), mixed (Burchiel Type 2a), or atypical (Burchiel Type 2b) TN. A pain-free status without medication was used to determine the efficacy of MVD. All patients were contacted in June 2008 and again in January 2009 at 12–24 months after surgery (median 18.4 months) and asked to rate their response to MVD as excellent (complete pain relief without medication), fair (complete pain relief with medication or some relief with or without medication), or poor (continued pain despite medication; that is, no change from their preoperative baseline pain status. Results Of 114 patients, 14 (12%) had isolated V2 TN. Among these 14 were 2 typical (14%), 1 mixed (7%), and 11 atypical cases (79%) of TN. Among the remaining 100 cases were 37 typical (37%), 14 mixed (14%), and 49 atypical cases (49%) of TN. In the isolated V2 TN group, all patients were women as compared with 72% of women in the larger group of 100 patients (p = 0.05, chi-square test). The average age in the isolated V2 TN group was 51.2 years (median 48.1 years) versus 54.2 years (median 54.0 years) in the remainder of the group (p = NS, unpaired Student t-test). In the isolated V2 TN group, there was a predominance of atypical pain cases (79%) versus 49% in the remainder of the group, and this finding trended toward statistical significance (p = 0.07, chi-square test). Venous contact or compression (partly or wholly) was noted in 93% of the patients with isolated V2 versus 69% of the remainder of the group (p = 0.13, chi-square test). The likelihood of excellent outcomes in the patients with V2 TN (71%) was compared with that in typical pain cases (79%) among patients in the rest of the group (that is, the bestoutcome group), and no difference was found between the 2 groups (p = 0.8, chi-square test). Conclusions The authors confirmed that patients with isolated V2 TN were more likely to be female, tended toward an atypical pain classification with venous pathology at surgery, and fared just as well as those presenting with typical pain.

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“…These results, obtained via an imaging protocol and confirmed by two blinded observers, agreed with observations made during surgery, 8,20 pathological examination of specimens collected during surgery and showing axonal loss and extensive demyelination, 4,10,12,18 and studies whose authors measured V and CSA using various noninvasive imaging methods. 5,11,13 Interobserver agreement was 0.7559 for measurements of V and 0.9024 for measurement of CSA (p < 0.01).…”

Section: Diagnostic Value Of Anatomical Tgn Parametersmentioning

confidence: 96%

Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

Leal¹,

Barbier

Hermier

et al. 2014

JNS

104

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S trong evidence suggests that in classic trigeminal neuralgia (TN) caused by neurovascular compression (NVC), the neuralgia is related to morphological and structural changes in the trigeminal nerve (TGN) that are probably the result of chronic vascular compression. Morphological changes in the nerve include nerve deviation, distortion, groove formation, and atrophy. 5 Atrophy of the nerve is seen in most cases of TN 20 and is probably attributable to structural abnormalities such as axonal loss and demyelination, 4,10,12,18 but these morphological changes are difficult to describe objectively. Object. The aim of this study was to prospectively evaluate atrophic changes in trigeminal nerves (TGNs) using measurements of volume (V) and cross-sectional area (CSA) from high-resolution 3-T MR images obtained in patients with unilateral trigeminal neuralgia (TN), and to correlate these data with patient and neurovascular compression (NVC) characteristics and with clinical outcomes.Methods. Anatomical TGN parameters (V and CSA) were obtained in 50 patients (30 women and 20 men; mean age 56.42 years, range 22-79 years) with classic TN before treatment with microvascular decompression (MVD). Parameters were compared between the symptomatic (ipsilateralTN) and asymptomatic (contralateralTN) sides of the face. Twenty normal control subjects were also included. Two independent observers blinded to the side of pain separately analyzed the images. Measurements of V (from the pons to the entrance of the nerve into Meckel's cave) and CSA (at 5 mm from the entry of the TGN into the pons) for each TGN were performed using imaging software and axial and coronal projections, respectively. These data were correlated with patient characteristics (age, duration of symptoms before MVD, side of pain, sex, and area of pain distribution), NVC characteristics (type of vessel involved in NVC, location of compression along the nerve, site of compression around the circumference of the root, and degree of compression), and clinical outcomes at the 2-year follow-up after surgery. Comparisons were made using Bonferroni's test. Interobserver variability was assessed using the Pearson correlation coefficient.Results. The mean V of the TGN on the ipsilateralTN (60.35 ± 21.74 mm 3 ) was significantly smaller (p < 0.05) than those for the contralateralTN and controls (78.62 ± 24.62 mm 3 and 89.09 ± 14.72 mm 3 , respectively). The mean CSA of the TGN on the ipsilateralTN (4.17 ± 1.74 mm 2 ) was significantly smaller than those for the contralateralTN and controls (5.41 ± 1.89 mm 2 and 5.64 ± 0.85 mm 2 , respectively). The ipsilateralTN with NVC Grade III (marked indentation) had a significantly smaller mean V than the ipsilateralTN with NVC Grade I (mere contact), although it was not significantly smaller than that of the ipsilateralTN with NVC Grade II (displacement or distortion of root). The ipsilateralTN with NVC Grade III had a significantly smaller mean CSA than the ipsilateralTN with NVC Grades I and II (p < 0.05). The TGN on the ipsilateralT...

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Neurovascular relationships in the posterior cranial fossa, with special reference to trigeminal neuralgia. 2. Neurovascular compression of the trigeminal nerve in cadaveric controls and patients with trigeminal neuralgia: Quantification and influence of method

Cited by 82 publications

References 18 publications

Different Pain, Different Brain: Thalamic Anatomy in Neuropathic and Non-Neuropathic Chronic Pain Syndromes

Different Pain, Different Brain: Thalamic Anatomy in Neuropathic and Non-Neuropathic Chronic Pain Syndromes

Microvascular decompression in patients with isolated maxillary division trigeminal neuralgia, with particular attention to venous pathology

Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

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