Trigeminal Nerve-Blood Vessel Relationship as Revealed by High-resolution Magnetic Resonance Imaging and Its Effect on Pain Relief after Gamma Knife Radiosurgery for Trigeminal Neuralgia

Brisman, Ronald; Khandji, Alexander G.; Mooij, Rob

doi:10.1227/00006123-200206000-00015

Cited by 16 publications

(23 citation statements)

References 23 publications

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“…Transitional zones of oculomotor and of lower cranial nerves are less well studied in humans and appear to be widely variable [41,42]. Because neurovascular contacts are often seen in asymptomatic patients, neurovascular conflict should only be diagnosed when nerve deviation or indentation is noted [1,38,43,44]. Possible offending vessels are a subject of controversy with some authors considering both arteries and veins as possible culprits, while others deny the role of veins due to their plasticity, low pressure and absent pulsatility [1,38].…”

Section: Neurovascular Conflictsmentioning

confidence: 99%

“…Possible offending vessels are a subject of controversy with some authors considering both arteries and veins as possible culprits, while others deny the role of veins due to their plasticity, low pressure and absent pulsatility [1,38]. Strict criteria for neurovascular conflict state that the offending vessel must be an artery, the site of contact must be the root entry zone, the vessel must cross the nerve perpendicularly, and the nerve must be deviated or indented by the vessel or compressed or encased between two or more adjacent vessels in the appropriate clinical setting [1,[43][44][45][46]. Other causes of neuralgia have to be excluded and, clinically, no other neurological deficits should be present.…”

Section: Neurovascular Conflictsmentioning

confidence: 99%

“…Vertebro-basilar dolichoectasia (Fig. 18), aneurysms, arteriovenous malformations and dural arteriovenous fistulas are also possible causes of neurovascular conflict with the trigeminal nerve [1,[43][44][45][46][47][48][49][50].…”

Section: Neurovascular Conflictsmentioning

confidence: 99%

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Imaging the cranial nerves: part II: primary and secondary neoplastic conditions and neurovascular conflicts

Borges

Casselman²

2007

Eur Radiol

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There have been unprecedented improvements in cross-sectional imaging in the last decades. The emergence of volumetric CT, higher field MR scanners and higher resolution MR sequences is largely responsible for the increasing diagnostic yield of imaging in patients presenting with cranial nerve deficits. The introduction of parallel MR imaging in combination with small surface coils allows the depiction of submillimetric nerves and nerve branches, and volumetric CT and MR imaging is able to provide high quality multiplanar and curved reconstructions that can follow the often complex course of cranial nerves. Seeking the cause of a cranial nerve deficit is a common indication for imaging, and it is not uncommon that radiologists are the first specialists to see a patient with a cranial neuropathy. To increase the diagnostic yield of imaging, high-resolution studies with smaller fields of view are required. To keep imaging studies within a reasonable time frame, it is mandatory to tailor the study according to neuro-topographic testing. This review article focuses on the contribution of current imaging techniques in the depiction of primary and secondary neoplastic conditions affecting the cranial nerves as well as on neurovascular conflicts, an increasingly recognized cause of cranial neuralgias.

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Section: Neurovascular Conflictsmentioning

confidence: 99%

Section: Neurovascular Conflictsmentioning

confidence: 99%

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Imaging the cranial nerves: part II: primary and secondary neoplastic conditions and neurovascular conflicts

Borges

Casselman²

2007

Eur Radiol

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“…This etiology, originally described by Dandy [11] and later popularized by Jannetta [2,12,13], has gained increasing weight with the works of Majoie et al [2,14] and Brisman et al [2,[15][16][17]. Among 181 patients with trigeminal neuralgia, collected by Brisman et al, 59% proved to have vascular compression of the trigeminal nerve [16].…”

Section: Pathologymentioning

confidence: 99%

Trigeminal neuralgia and facial nerve paralysis

Borges¹

2005

Eur Radiol

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The trigeminal nerve is the largest of the cranial nerves. It provides sensory input from the face and motor innervation to the muscles of mastication. The facial nerve is the cranial nerve with the longest extracranial course, and its main functions include motor innervation to the muscles of facial expression, sensory control of lacrimation and salivation, control of the stapedial reflex and to carry taste sensation from the anterior two-thirds of the tongue. In order to be able adequately to image and follow the course of these cranial nerves and their main branches, a detailed knowledge of neuroanatomy is required. As we are dealing with very small anatomic structures, high resolution dedicated imaging studies are required to pick up normal and pathologic nerves. Whereas CT is best suited to demonstrate bony neurovascular foramina and canals, MRI is preferred to directly visualize the nerve. It is also the single technique able to detect pathologic processes afflicting the nerve without causing considerable expansion such as is usually the case in certain inflammatory/infectious conditions, perineural spread of malignancies and in very small intrinsic tumours. Because a long course from the brainstem nuclei to the peripheral branches is seen, it is useful to subdivide the nerve in several segments and then tailor the imaging modality and the imaging study to that specific segment. This is particularly true in cases where topographic diagnosis can be used to locate a lesion in the course of these nerves.

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“…Although primary surgical treatment is effective in most patients, pain recurs in a significant subset; patients who have persistent or recurrent symptoms despite intervention represent approximately 10% to 30% of patients who undergo microvascular decompression (MVD), 20% to 50% of those who undergo a percutaneous destructive procedure, and 30% to 40% of those who undergo gamma knife radiosurgery (GKRS) (1)(2)(3)(4)(5)(6)(7)(8)(9). Because it has a low incidence of adverse effects, is an outpatient procedure, and does not prevent the subsequent use of more invasive modalities should they be necessary, GKRS has been used as an alternative to MVD and percutaneous lesioning techniques in an attempt to salvage these patients.…”

Section: Introductionmentioning

confidence: 99%

Salvage Gamma Knife Stereotactic Radiosurgery for Surgically Refractory Trigeminal Neuralgia

Little

Shetter

et al. 2009

International Journal of Radiation Oncology*Biology*Physics

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Trigeminal Nerve-Blood Vessel Relationship as Revealed by High-resolution Magnetic Resonance Imaging and Its Effect on Pain Relief after Gamma Knife Radiosurgery for Trigeminal Neuralgia

Cited by 16 publications

References 23 publications

Imaging the cranial nerves: part II: primary and secondary neoplastic conditions and neurovascular conflicts

Imaging the cranial nerves: part II: primary and secondary neoplastic conditions and neurovascular conflicts

Trigeminal neuralgia and facial nerve paralysis

Salvage Gamma Knife Stereotactic Radiosurgery for Surgically Refractory Trigeminal Neuralgia

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