Preoperative detection of the neurovascular relationship in trigeminal neuralgia using three-dimensional fast imaging employing steady-state acquisition (FIESTA) and magnetic resonance angiography (MRA)

Zeng, Qingshi; Zhou, Quan; Liu, ZhiLing; Li, Chuanfu; Ni, Shilei; Xue, Feng

doi:10.1016/j.jocn.2012.01.046

Cited by 56 publications

(37 citation statements)

References 25 publications

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“…31 32 Some small studies with more sophisticated technology have suggested improved correlations but these technologies are not available routinely at present. 36 However, more sophisticated techniques have been used recently, as reported in small series, which have shown actual changes in the trigeminal nerve. 37 38 …”

Section: Red Flagsmentioning

confidence: 99%

Trigeminal neuralgia

Zakrzewska

Linskey

2014

BMJ

214

197

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Section: Red Flagsmentioning

confidence: 99%

Trigeminal neuralgia

Zakrzewska

Linskey

2014

BMJ

214

197

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“…Advances in MRI have been playing an important role in the diagnostic setting, especially in the presurgical evaluation of TN patient in order to identify secondary causes of TN and/or the neurovascular conflict. Studies have been published17,18 on the usefulness of three-dimensional fast imaging employing steady-state acquisition and magnetic resonance angiography (MRA) in surgical planning and prediction of surgical findings during micro-vascular decompression (MVD). A correlation more than 95% between this method and surgical findings has been demonstrated 17,18…”

Section: Advances In Diagnosismentioning

confidence: 99%

Advances in diagnosis and treatment of trigeminal neuralgia

Montano¹,

Conforti²,

Bonaventura³

et al. 2015

TCRM

148

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Various drugs and surgical procedures have been utilized for the treatment of trigeminal neuralgia (TN). Despite numerous available approaches, the results are not completely satisfying. The need for more contemporaneous drugs to control the pain attacks is a common experience. Moreover, a number of patients become drug resistant, needing a surgical procedure to treat the neuralgia. Nonetheless, pain recurrence after one or more surgical operations is also frequently seen. These facts reflect the lack of the precise understanding of the TN pathogenesis. Classically, it has been related to a neurovascular compression at the trigeminal nerve root entry-zone in the prepontine cistern. However, it has been evidenced that in the pain onset and recurrence, various neurophysiological mechanisms other than the neurovascular conflict are involved. Recently, the introduction of new magnetic resonance techniques, such as voxel-based morphometry, diffusion tensor imaging, three-dimensional time-of-flight magnetic resonance angiography, and fluid attenuated inversion recovery sequences, has provided new insight about the TN pathogenesis. Some of these new sequences have also been used to better preoperatively evidence the neurovascular conflict in the surgical planning of microvascular decompression. Moreover, the endoscopy (during microvascular decompression) and the intraoperative computed tomography with integrated neuronavigation (during percutaneous procedures) have been recently introduced in the challenging cases. In the last few years, efforts have been made in order to better define the optimal target when performing the gamma knife radiosurgery. Moreover, some authors have also evidenced that neurostimulation might represent an opportunity in TN refractory to other surgical treatments. The aim of this work was to review the recent literature about the pathogenesis, diagnosis, and medical and surgical treatments, and discuss the significant advances in all these fields.

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“…8,10,13,21 Structural changes in the trigeminal nerve, leading to volume loss, have been well documented, 3,6,12 and a number of studies have demonstrated that nerve atrophy ipsilateral to the symptomatic side is visible on preoperative MRI. 1,4,5,7,9,15,17 Recently, Leal et al demonstrated that atrophy in the midcisternal region of the nerve is associated with more severe vascular compression, and these patients tend to exhibit greater clinical improvement following surgical decompression of the nerve.…”

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confidence: 99%

Degree of distal trigeminal nerve atrophy predicts outcome after microvascular decompression for Type 1a trigeminal neuralgia

Duan

Sweet

Munyon

et al. 2015

JNS

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obJect Trigeminal neuralgia is often associated with nerve atrophy, in addition to vascular compression. The authors evaluated whether cross-sectional areas of different portions of the trigeminal nerve on preoperative imaging could be used to predict outcome after microvascular decompression (MVD). methods A total of 26 consecutive patients with unilateral Type 1a trigeminal neuralgia underwent high-resolution fast-field echo MRI of the cerebellopontine angle followed by MVD. Preoperative images were reconstructed and reviewed by 2 examiners blinded to the side of symptoms and clinical outcome. For each nerve, a computerized automatic segmentation algorithm was used to calculate the coronal cross-sectional area at the proximal nerve near the root entry zone and the distal nerve at the exit from the porus trigeminus. Findings were correlated with outcome at 12 months. results After MVD, 17 patients were pain free and not taking medications compared with 9 with residual pain. Across all cases, the coronal cross-sectional area of the symptomatic trigeminal nerve was significantly smaller than the asymptomatic side in the proximal part of the nerve, which was correlated with degree of compression at surgery. Atrophy of the distal trigeminal nerve was more pronounced in patients who had residual pain than in those with excellent outcome. Among the 7 patients who had greater than 20% loss of nerve volume in the distal nerve, only 2 were pain free and not taking medications at long-term follow-up. coNclusioNs Trigeminal neuralgia is associated with atrophy of the root entry zone of the affected nerve compared with the asymptomatic side, but volume loss in different segments of the nerve has very different prognostic implications. Proximal atrophy is associated with vascular compression and correlates with improved outcome following MVD. However, distal atrophy is associated with a significantly worse outcome after MVD.

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Preoperative detection of the neurovascular relationship in trigeminal neuralgia using three-dimensional fast imaging employing steady-state acquisition (FIESTA) and magnetic resonance angiography (MRA)

Cited by 56 publications

References 25 publications

Trigeminal neuralgia

Trigeminal neuralgia

Advances in diagnosis and treatment of trigeminal neuralgia

Degree of distal trigeminal nerve atrophy predicts outcome after microvascular decompression for Type 1a trigeminal neuralgia

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