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Kumar A, Kubota Y, Yokosako S, Chernov M. Radiological Characteristics of the Affected Trigeminal Nerve in Cases of Trigeminal Neuralgia Caused by Pure Venous Conflict. World Neurosurg 2025; 194:123500. [PMID: 39581467 DOI: 10.1016/j.wneu.2024.11.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 11/15/2024] [Accepted: 11/16/2024] [Indexed: 11/26/2024]
Abstract
OBJECTIVE To assess radiological characteristics that may support the clinical diagnosis of trigeminal neuralgia caused by pure venous conflict. METHODS Preoperative constructive interference in steady state images were analyzed retrospectively in 30 patients with trigeminal neuralgia caused by pure venous conflict, which was confirmed during microvascular decompression. Length, width, T2 hyperintensity, and shape of the cisternal segment of trigeminal nerve (CN V), as well as sizes of the trigeminal-pontine angle, trigeminal-petrous angle, and cerebellopontine cistern were evaluated on both sides. RESULTS On the affected side, the length of CN V was significantly shorter (mean 7.9 mm vs. 9.0 mm, P = 0.0249), whereas its width in midportion (mean 4.0 mm vs. 3.5 mm, P = 0.0022) and the size of the trigeminal-pontine angle (mean 55.3° vs. 48.8°, P = 0.0052) were significantly larger. Other evaluated characteristics did not differ significantly between affected and nonaffected sides. Statistically significant odds ratio (OR) for the association with affected side was revealed for shorter length (OR 10.5, P = 0.0319) and larger width (OR 8.8, P = 0.0487) of CN V; the presence of either of these parameters (i.e., shorter and/or thicker CN V) provided the highest discriminative value (OR 19.3, P = 0.0063). CONCLUSIONS Identification of shorter and/or thicker CN V on the affected side in patients with trigeminal neuralgia without an obvious offending vessel on magnetic resonance imaging may suggest the presence of pure venous conflict and help with decision making about microvascular decompression.
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Affiliation(s)
- Amit Kumar
- Department of Neurosciences, Bhagwan Mahavir MEDICA Superspecialty Hospital, Ranchi, Jharkhand, India; Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Yuichi Kubota
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan.
| | - Suguru Yokosako
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Mikhail Chernov
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
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Sato A, Tanaka Y, Ishiwada T, Arai Y, Takei T, Maehara T. Comparative Analysis of Patients Undergoing Microvascular Decompression for Trigeminal Neuralgia Caused by Solely Arterial or Solely Venous Compression. World Neurosurg 2024; 189:e1034-e1039. [PMID: 39013499 DOI: 10.1016/j.wneu.2024.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/07/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) due to venous compression is far less common than that due to arterial compression, and its pathogenesis is less clear. We investigated the clinical and imaging features of TN caused by solely venous compression by measuring the morphologies of the posterior cranial fossa (PCF) and the trigeminal nerve. METHODS We retrospectively reviewed records of TN patients who underwent microvascular decompression at our institution and extracted cases with solely arterial or solely venous compression. Preoperative magnetic resonance imaging was used to find the length (Y), width (X), height (Z), and volume (V) of the PCF, the angle between the trigeminal nerve and pons, and the distance between Meckel's cave and the root entry zone of the trigeminal nerve. RESULTS Of 152 patients, 24 had TN caused solely by venous compression. The value of Y was significantly smaller in the venous group than the arterial group (P < 0.01). The trigeminal nerve and pons was significantly smaller in the venous group (P < 0.01). We hypothesized that TN patients with solely venous compression had a characteristic PCF morphology with a short anteroposterior diameter (Y), such that age-related changes in brain morphology could alter the course of the trigeminal nerve and cause compression by a vein. CONCLUSIONS The morphological features of the PCF differed between patients with TN of venous and those with TN of arterial etiology. Age-related changes in brain morphology and changes of course of the trigeminal nerve may also add to the possibility of developing TN, especially of venous etiology.
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Affiliation(s)
- Akihito Sato
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Tadahiro Ishiwada
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yukika Arai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takamaro Takei
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
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Bora N, Parihar P, Raj N, Shetty N, Nunna B. A Systematic Review of the Role of Magnetic Resonance Imaging in the Diagnosis and Detection of Neurovascular Conflict in Patients With Trigeminal Neuralgia. Cureus 2023; 15:e44614. [PMID: 37799230 PMCID: PMC10547583 DOI: 10.7759/cureus.44614] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/03/2023] [Indexed: 10/07/2023] Open
Abstract
Trigeminal neuralgia (TN) is a debilitating disorder causing severe, episodic, unilateral stabbing facial pain disturbing enough to disrupt the activities of daily life. Classic TN is caused due to compression injury of the trigeminal nerve at the cistern segment caused by either an artery or a vein, referred to as neurovascular contact or conflict (NVC). Magnetic resonance imaging (MRI) has been the standard tool for the diagnosis of NVC. This study aimed to determine the incidence of NVC in TN, as identified by MRI, assess the various MRI grading patterns among patients with TN, and identify the vessels primarily involved in NVC. A systematic search of studies that used MRI for the diagnosis of TN in reference to NVC was conducted on DOAJ and PubMed/PubMed Central. Data were extracted and entered into a Microsoft Excel spreadsheet. The outcomes measured were the incidence of NVC as shown in MRI, vessels involved in NVC, and MRI grading patterns. We identified and selected 20 studies that fulfilled inclusion/exclusion criteria. In total, 1,436 patients were enrolled in all included studies. The type of MRI used was 1.5 T or 3 T MRI. The mean age of the patients varied from 49 to 63 years, with an equivalent male-to-female ratio. NVC was seen in 1,276 cases out of 1,436 cases (88.85%) of TN on the ipsilateral side, as shown by MRI. The vessels involved were arteries in 80-90% of the cases, followed by veins. Among the arteries, the superior cerebellar artery was the most common artery (80-90% of cases). The grades of NVC as assessed by MRI included grades I, II, and III with varied proportions in different studies. NVC is a common problem in TN, wherein there is compression at the nerve root entry zone, and it shows a strong predilection for the elderly population. MRI seems to be a novel imaging diagnostic investigation to identify NVC associated with TN. Moreover, NVC grading must be done with MRI so that it may help the surgeon in stratifying the patient's treatment.
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Affiliation(s)
- Nikita Bora
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratap Parihar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishant Raj
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neha Shetty
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhagyasri Nunna
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Liang C, Yang L, Reichardt W, Zhang B, Li R. Different MRI-based methods for the diagnosis of neurovascular compression in trigeminal neuralgia or hemifacial spasm: A network meta-analysis. J Clin Neurosci 2023; 108:19-24. [PMID: 36577319 DOI: 10.1016/j.jocn.2022.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Accurate preoperative diagnosis of neurovascular compression (NVC) is crucial in the treatment of trigeminal neuralgia (TN) or hemifacial spasm (HFS). At present, there are many magnetic resonance imaging (MRI)-based methods for diagnosing NVC in clinical practice. This network meta-analysis (NMA) aimed to evaluate the diagnostic performance of different MRI-based imaging methods for NVC in patients with TN and HFS. MATERIALS AND METHODS Related studies based on a search of PubMed, Embase, Web of Science and the Cochrane Library were retrieved. A two-way analysis of variance model was constructed for the Bayesian NMA to compare the performance of different diagnostic imaging methods. RESULTS Our search identified 595 articles, of which 26 studies (including 2085 patients) related to 4 diagnostic imaging methods (3D time-of-flight magnetic resonance angiography (3D TOF MRA), high resolution T2-weighted imaging (HR T2WI), 3D TOF MRA combined with HR T2WI, and 3D multimodal image fusion (MIF) based on 3D TOF MRA combined with HR T2WI) were included in this NMA. The results showed that 3D MIF based on 3D TOF MRA combined with HR T2WI had the highest related sensitivity, the highest superiority index and the largest area under the receiver operating characteristic curve among all the methods. CONCLUSIONS 3D MIF based on 3D TOF MRA combined with HR T2WI had better diagnostic performance for detecting NVC in patients with TN or HSF than other MRI-based imaging methods. This method can be used as an effective tool for preoperative evaluation of MVD.
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Affiliation(s)
- Chen Liang
- Department of Neurosurgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China; Department of Radiology Medical Physics, University Medical Center Freiburg, University of Freiburg, Freiburg 79106, Germany.
| | - Ling Yang
- Department of Aviation Psychology Research, Xi'an Civil Aviation Hospital, Xi'an 710082, Shaanxi Province, China
| | - Wilfried Reichardt
- Department of Radiology Medical Physics, University Medical Center Freiburg, University of Freiburg, Freiburg 79106, Germany
| | - Binbin Zhang
- Department of Neurosurgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Ruichun Li
- Department of Neurosurgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
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Liang C, Yang L, Zhang BB, Guo SW, Li RC. Three-dimensional time-of-flight magnetic resonance angiography combined with high resolution T2-weighted imaging in preoperative evaluation of microvascular decompression. World J Clin Cases 2022; 10:12594-12604. [PMID: 36579121 PMCID: PMC9791536 DOI: 10.12998/wjcc.v10.i34.12594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/29/2022] [Accepted: 11/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Neurovascular compression (NVC) is the main cause of primary trigeminal neuralgia (TN) and hemifacial spasm (HFS). Microvascular decompression (MVD) is an effective surgical method for the treatment of TN and HFS caused by NVC. The judgement of NVC is a critical step in the preoperative evaluation of MVD, which is related to the effect of MVD treatment. Magnetic resonance imaging (MRI) technology has been used to detect NVC prior to MVD for several years. Among many MRI sequences, three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is the most widely used. However, 3D TOF MRA has some shortcomings in detecting NVC. Therefore, 3D TOF MRA combined with high resolution T2-weighted imaging (HR T2WI) is considered to be a more effective method to detect NVC.
AIM To determine the value of 3D TOF MRA combined with HR T2WI in the judgment of NVC, and thus to assess its value in the preoperative evaluation of MVD.
METHODS Related studies published from inception to September 2022 based on PubMed, Embase, Web of Science, and the Cochrane Library were retrieved. Studies that investigated 3D TOF MRA combined with HR T2WI to judge NVC in patients with TN or HFS were included according to the inclusion criteria. Studies without complete data or not relevant to the research topics were excluded. The Quality Assessment of Diagnostic Accuracy Studies checklist was used to assess the quality of included studies. The publication bias of the included literature was examined by Deeks’ test. An exact binomial rendition of the bivariate mixed-effects regression model was used to synthesize data. Data analysis was performed using the MIDAS module of statistical software Stata 16.0. Two independent investigators extracted patient and study characteristics, and discrepancies were resolved by consensus. Individual and pooled sensitivities and specificities were calculated. The I² statistic and Q test were used to test heterogeneity. The study was registered on the website of PROSERO (registration No. CRD42022357158).
RESULTS Our search identified 595 articles, of which 12 (including 855 patients) fulfilled the inclusion criteria. Bivariate analysis showed that the pooled sensitivity and specificity of 3D TOF MRA combined with HR T2WI for detecting NVC were 0.96 [95% confidence interval (CI): 0.92-0.98] and 0.92 (95%CI: 0.74-0.98), respectively. The pooled positive likelihood ratio was 12.4 (95%CI: 3.2-47.8), pooled negative likelihood ratio was 0.04 (95%CI: 0.02-0.09), and pooled diagnostic odds ratio was 283 (95%CI: 50-1620). The area under the receiver operating characteristic curve was 0.98 (95%CI: 0.97-0.99). The studies showed no substantial heterogeneity (I2= 0, Q = 0.001 P = 0.50).
CONCLUSION Our results suggest that 3D TOF MRA combined with HR T2WI has excellent sensitivity and specificity for judging NVC in patients with TN or HFS. This method can be used as an effective tool for preoperative evaluation of MVD.
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Affiliation(s)
- Chen Liang
- Department of Neurosurgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of Radiology Medical Physics, University Medical Center Freiburg, University of Freiburg, Freiburg 79108, Germany
| | - Ling Yang
- Department of Aviation Psychology Research, Xi’an Civil Aviation Hospital, Xi’an 710082, Shaanxi Province, China
| | - Bin-Bin Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Shi-Wen Guo
- Department of Neurosurgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Rui-Chun Li
- Department of Neurosurgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
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Maltsev D, Fedirko V. Refractory atypical trigeminal neuralgia associated with reactivated herpesvirus infection: pathogenetic link and efficacy of combination antiviral therapy. Virusdisease 2022; 33:155-165. [DOI: 10.1007/s13337-022-00769-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022] Open
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