Triantafyllou G, Papadopoulos-Manolarakis P, Arkoudis NA, Moschovaki-Zeiger O, Velonakis G, Piagkou M. Magnetic resonance imaging-based classification of trigeminal nerve-superior cerebellar artery relationships. World J Radiol 2025; 17(12): 116453 [DOI: 10.4329/wjr.v17.i12.116453]
Corresponding Author of This Article
Maria Piagkou, DDS, MD, PhD, Professor, Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens 11527, Attikí, Greece. mapian@med.uoa.gr
Research Domain of This Article
Anatomy & Morphology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Dec 28, 2025; 17(12): 116453 Published online Dec 28, 2025. doi: 10.4329/wjr.v17.i12.116453
Magnetic resonance imaging-based classification of trigeminal nerve-superior cerebellar artery relationships
George Triantafyllou, Panagiotis Papadopoulos-Manolarakis, Nikolaos-Achilleas Arkoudis, Ornella Moschovaki-Zeiger, Georgios Velonakis, Maria Piagkou
George Triantafyllou, Panagiotis Papadopoulos-Manolarakis, Maria Piagkou, Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens 11527, Attikí, Greece
Panagiotis Papadopoulos-Manolarakis, Department of Neurosurgery, General Hospital of Nikaia-Piraeus, Athens 18454, Attikí, Greece
Nikolaos-Achilleas Arkoudis, Georgios Velonakis, Research Unit of Radiology and Medical Imaging, National and Kapodistrian University of Athens, Athens 11528, Attikí, Greece
Nikolaos-Achilleas Arkoudis, Ornella Moschovaki-Zeiger, Georgios Velonakis, Second Department of Radiology, General University Hospital “Attikon”, National and Kapodistrian University of Athens, Athens 12462, Attikí, Greece
Author contributions: Triantafyllou G contributed to conceptualization and project development; Arkoudis NA and Moschovaki-Zeiger O contributed to data collection; Velonakis G and Piagkou M provided supervision; Triantafyllou G, Papadopoulos-Manolarakis P, Arkoudis NA, Moschovaki-Zeiger O, Velonakis G, and Piagkou M participated in data analysis, writing, reviewing, and editing; and all authors have read and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of General Hospital of Nikaia-Piraeus, approval No. 13.11.2024.
Informed consent statement: Patients provided informed consent for the current study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Please contact the authors for data requests.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maria Piagkou, DDS, MD, PhD, Professor, Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens 11527, Attikí, Greece. mapian@med.uoa.gr
Received: November 12, 2025 Revised: November 25, 2025 Accepted: December 10, 2025 Published online: December 28, 2025 Processing time: 44 Days and 21.3 Hours
Abstract
BACKGROUND
The trigeminal nerve (TN) is frequently implicated in neurovascular conflicts, most commonly with the superior cerebellar artery (SCA), its predominant arterial counterpart in the cerebellopontine angle.
AIM
To examine the relationship between the SCA and TN utilizing high-resolution magnetic resonance imaging and evaluated whether particular anatomical configurations predispose to clinically significant contact.
METHODS
Magnetic resonance imaging scans from 80 patients (160 sides) were retrospectively analyzed, excluding cases with pathological processes affecting the TN. Using multiplanar reconstruction, the TN root was identified and its spatial relationship with the SCA was evaluated.
RESULTS
Eight distinct topographic patterns were identified. The SCA most commonly coursed superior (30.6%), lateral (18.8%), or superolateral (17.5%) to the TN. Medial configurations, although less frequent, were associated with the shortest artery-nerve distance (mean 1.85 ± 1.28 mm) and significantly higher contact rates (P < 0.001). Overall, SCA-TN contact was observed in 14.4% of sides, but only 20% of these patients reported ipsilateral facial numbness. Variations in SCA origin (basilar artery, posterior cerebral artery, or common origin) and duplication did not significantly influence the artery-nerve distance.
CONCLUSION
Although SCA-TN contact is relatively frequent, only particular medial and superior configurations seem to predispose individuals to symptomatic compression. These observations are consistent with cadaveric and surgical evidence highlighting the significance of root entry zone contact in trigeminal neuralgia. Vascular contact alone should not serve as a diagnostic criterion; instead, geometric configuration and related nerve alterations must also be incorporated into preoperative assessment.
Core Tip: This study examined the relationship between the superior cerebellar artery and trigeminal nerve utilizing high-resolution magnetic resonance imaging and evaluated whether particular anatomical configurations predispose to clinically significant contact. Eight distinct topographical patterns were identified. Medial configuration predisposed to shortest distance, significant higher contact rates, and in some cases, ipsilateral facial numbness. The proposed classification system could be used from anatomists, radiologists and neurosurgeons - for proper understanding of the relationship between these two structures.
