Structural abnormalities of the trigeminal root revealed by diffusion tensor imaging in patients with trigeminal neuralgia caused by neurovascular compression: A prospective, double-blind, controlled study

Leal, Paulo Roberto Lacerda; Roch, Jean Amédée; Hermier, M.; Souza, Miguel Angelo N.; Cristino-Filho, Gerardo; Sindou, Marc

doi:10.1016/j.pain.2011.06.029

Cited by 116 publications

(84 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…20,21 Moreover, the type of offending vessel can be accurately determined. In our study, using CE-MRA data, the respective vessel was anatomically and correctly identified by 2 blinded and independent neuroradiological evaluations and matched the intraoperative findings in 78 patients.…”

Section: Discussionmentioning

confidence: 99%

“…8,21,27 FA and ADC represent the 2 DTI indices that are most widely used because they reliably indicate abnormalities in white matter tracts, independent of their cause. 3,26,30 The measurement of FA provides robust values for quantifying the degree of directionality of diffusion (i.e., anisotropic diffusion) as a marker of microstructural integrity.…”

Section: Dti Of Tn Due To Neurovascular Compressionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Dti Of Tn Due To Neurovascular Compressionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…More recently, two teams used 3-T MRI to measure V and/or CSA. 6,17 According to Fujiwara et al, 6 the mean CSA on the ipsilateralTN in 13 patients (3.9 ± 0.8 mm 2 ) was significantly smaller than that on the contralateralTN (5. ).…”

Section: Diagnostic Value Of Anatomical Tgn Parametersmentioning

confidence: 97%

“…5,6,11,13,17 In 2005, Kress et al 13 measured V in 62 patients (41 with TN, including 6 patients with multiple sclerosis) with one investigator using 1.5-T MRI in 50 normal subjects. In that study, the mean V on the ipsilateralTN was 69.6 mm 3 (95% CI 37.2-110.6) and that on the contralateralTN was 84.5 mm 3 (95% CI 50.3-141.1).…”

Section: Diagnostic Value Of Anatomical Tgn Parametersmentioning

confidence: 99%

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

Self Cite

View full text Add to dashboard Cite

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...

show abstract

“…This neuropathic disorder can be profoundly distressing and may negatively affect wellbeing (7). Compression of the trigeminal nerve root by an artery, or more rarely a vein, is demonstrable in 90-95% of patients, according to findings from a series of patients who underwent microvascular decompression for TN (8). TN often causes depression and has even resulted in suicide in some individuals.…”

Section: Introductionmentioning

confidence: 99%

Pain intensity and psychosocial characteristics of patients with burning mouth syndrome and trigeminal neuralgia

et al. 2012

View full text Add to dashboard Cite

This study compared pain intensity and psychosocial characteristics between patients with burning mouth syndrome (BMS) and those with trigeminal neuralgia (TN). Data from 282 patients with BMS and 83 patients with TN were analyzed. Patients reported duration of illness: duration ≤ 6 months was defined as acute illness and > 6 months as chronic illness. Present pain intensity and worst pain intensity during the past 6 months were reported using a 0-10 numeric rating scale (NRS). In addition, depression and somatization scores were evaluated on questionnaires. Patients with chronic BMS reported significantly higher pain intensity and had worse psychosocial characteristics than did those with acute BMS. Pain intensity was higher in TN patients than in BMS patients, although neither pain intensity nor psychosocial characteristics significantly differed between patients with acute and chronic illness.Logistic regression analysis of BMS and TN patients revealed that the odds ratio for worst pain was significantly lower for BMS patients than for TN patients and that the odds ratio for somatization score was 3.8 times higher in BMS patients. These findings suggest that BMS patients may require pain control targeting the central nervous system or psychosocial characteristics. (J Oral Sci 54, 321-327, 2012)

show abstract

Structural abnormalities of the trigeminal root revealed by diffusion tensor imaging in patients with trigeminal neuralgia caused by neurovascular compression: A prospective, double-blind, controlled study

Cited by 116 publications

References 34 publications

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

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

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

Pain intensity and psychosocial characteristics of patients with burning mouth syndrome and trigeminal neuralgia

Contact Info

Product

Resources

About