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Li Y, Cao B, Wang Y, Shi H, Du Y, Shi H, Zhang K, Qian T. Evaluation of the correlation between trigeminal nerve atrophy and trigeminal neuralgia using multimodal image fusion: A single-center retrospective study. Clin Neurol Neurosurg 2024; 243:108387. [PMID: 38924844 DOI: 10.1016/j.clineuro.2024.108387] [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: 05/26/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND 3D-Slicer is an open-source medical image processing and visualization software. In the surgical treatment of trigeminal neuralgia, it is commonly used to predict the responsible vessels. However, there are few reports on the use of 3D-Slicer software to quantitatively measure the bilateral trigeminal nerve volume in patients with primary trigeminal neuralgia (PTN) based on the three-dimensional images. Therefore, this study aims to explore the role of three-dimensional fused images processed by 3D-Slicer in the evaluation of trigeminal nerve atrophy, providing an objective basis for the diagnosis of PTN. METHODS 57 PTN patients who underwent microvascular decompression (MVD) or percutaneous balloon compression (PBC) surgery in Hebei general hospital between January 2020 and April 2023 were included. Additionally, 30 patients with facial spasms(HFS) were included as a control group. All patients underwent 3D-TOF-MRA and 3D-FIESTA sequence examinations. Comparisons of bilateral trigeminal nerve volumes within and between groups were conducted by performing image fusion using 3D-slicer. RESULTS The volume of the affected trigeminal nerve in the MVD group (33.96 mm³±12.61 mm³) and PBC group (23.05 mm³±7.71 mm³) was smaller than that of the unaffected trigeminal nerve in the MVD group (39.61 mm³±12.83 mm³) and PBC group (26.14 mm³±6.42 mm³), as well as the average volume of the trigeminal nerve in the control group (40.27 mm³±10.25 mm³) (P<0.05). The differences in bilateral trigeminal ganglion volume (∆V) was significant between the MVD group (∆V=23.59 %±14.32 %) and the control group (∆V=14.64 %±10.00 %) (P<0.05). There was no statistical difference in the trigeminal nerve volume difference between the MVD group (∆V=23.59 %±14.32 %) and the PBC group (∆V=26.52 %±15.00 %) (P>0.05). CONCLUSION Trigeminal nerve atrophy is correlated with primary trigeminal neuralgia. 3D-slicer software can quantitatively measure trigeminal nerve volume and assist in the diagnosis of primary trigeminal neuralgia based on the difference in bilateral trigeminal nerve volumes. However, trigeminal nerve atrophy is not associated with postoperative pain recurrence in patients.
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Affiliation(s)
- Yang Li
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang City, Hebei Province, China
| | - Boyang Cao
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang City, Hebei Province, China; Hebei Medical University, Shijiazhuang City, Hebei Province, China
| | - Yinzhan Wang
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang City, Hebei Province, China
| | - Hailiang Shi
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang City, Hebei Province, China
| | - Yihui Du
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang City, Hebei Province, China
| | - Haowei Shi
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang City, Hebei Province, China
| | - Kuo Zhang
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang City, Hebei Province, China
| | - Tao Qian
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang City, Hebei Province, China.
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Allam AK, Larkin MB, Sharma H, Viswanathan A. Trigeminal and Glossopharyngeal Neuralgia. Neurol Clin 2024; 42:585-598. [PMID: 38575268 DOI: 10.1016/j.ncl.2023.12.011] [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] [Indexed: 04/06/2024]
Abstract
Trigeminal neuralgia and glossopharyngeal neuralgia are craniofacial pain syndromes characterized by recurrent brief shock-like pains in the distributions of their respective cranial nerves. In this article, the authors aim to summarize each condition's characteristics, pathophysiology, and current pharmacotherapeutic and surgical interventions available for managing and treating these conditions.
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Affiliation(s)
- Anthony K Allam
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - M Benjamin Larkin
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Himanshu Sharma
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
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Wang Z, Peng R, Zhang Z, Yan K. Hemimasticatory spasm caused by single venous compression of the root of the trigeminal nerve: An MRI study for a case report and review of literature. Radiol Case Rep 2024; 19:1624-1628. [PMID: 38333901 PMCID: PMC10850115 DOI: 10.1016/j.radcr.2024.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 02/10/2024] Open
Abstract
Hemimasticatory spasm is a very rare disorder of the trigeminal nerve characterized by paroxysmal involuntary contraction of the jaw-closing muscles. Although its cause is not fully known, vascular compression of the trigeminal nerve is thought to be involved. Magnetic resonance imaging (MRI) can indicate continuing vascular compression for hemimasticatory spasm. Here, we report a case of hemimasticatory spasm that was caused by single venous compression of the trigeminal nerve root on MRI and was confirmed by microvascular decompression surgery.
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Affiliation(s)
- Zhiqing Wang
- Department of Radiology, Medical Imaging Center, Panzhihua Central Hospital, Yikang St no. 34, Panzhihua, Sichuan Province 617067, PR China
| | - Rong Peng
- Department of Radiology, Medical Imaging Center, Panzhihua Central Hospital, Yikang St no. 34, Panzhihua, Sichuan Province 617067, PR China
| | - Zeming Zhang
- Department of Radiology, Medical Imaging Center, Panzhihua Central Hospital, Yikang St no. 34, Panzhihua, Sichuan Province 617067, PR China
| | - Kekun Yan
- Department of Functional Neurosurgery, Panzhihua Central Hospital, Yikang St no. 34, Panzhihua, Sichuan Province 617067, PR China
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Zhang C, Li M, Luo Z, Xiao R, Li B, Shi J, Zeng C, Sun B, Xu X, Yang H. Deep learning-driven MRI trigeminal nerve segmentation with SEVB-net. Front Neurosci 2023; 17:1265032. [PMID: 37920295 PMCID: PMC10618361 DOI: 10.3389/fnins.2023.1265032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/29/2023] [Indexed: 11/04/2023] Open
Abstract
Purpose Trigeminal neuralgia (TN) poses significant challenges in its diagnosis and treatment due to its extreme pain. Magnetic resonance imaging (MRI) plays a crucial role in diagnosing TN and understanding its pathogenesis. Manual delineation of the trigeminal nerve in volumetric images is time-consuming and subjective. This study introduces a Squeeze and Excitation with BottleNeck V-Net (SEVB-Net), a novel approach for the automatic segmentation of the trigeminal nerve in three-dimensional T2 MRI volumes. Methods We enrolled 88 patients with trigeminal neuralgia and 99 healthy volunteers, dividing them into training and testing groups. The SEVB-Net was designed for end-to-end training, taking three-dimensional T2 images as input and producing a segmentation volume of the same size. We assessed the performance of the basic V-Net, nnUNet, and SEVB-Net models by calculating the Dice similarity coefficient (DSC), sensitivity, precision, and network complexity. Additionally, we used the Mann-Whitney U test to compare the time required for manual segmentation and automatic segmentation with manual modification. Results In the testing group, the experimental results demonstrated that the proposed method achieved state-of-the-art performance. SEVB-Net combined with the ωDoubleLoss loss function achieved a DSC ranging from 0.6070 to 0.7923. SEVB-Net combined with the ωDoubleLoss method and nnUNet combined with the DoubleLoss method, achieved DSC, sensitivity, and precision values exceeding 0.7. However, SEVB-Net significantly reduced the number of parameters (2.20 M), memory consumption (11.41 MB), and model size (17.02 MB), resulting in improved computation and forward time compared with nnUNet. The difference in average time between manual segmentation and automatic segmentation with manual modification for both radiologists was statistically significant (p < 0.001). Conclusion The experimental results demonstrate that the proposed method can automatically segment the root and three main branches of the trigeminal nerve in three-dimensional T2 images. SEVB-Net, compared with the basic V-Net model, showed improved segmentation performance and achieved a level similar to nnUNet. The segmentation volumes of both SEVB-Net and nnUNet aligned with expert annotations but SEVB-Net displayed a more lightweight feature.
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Affiliation(s)
- Chuan Zhang
- The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Man Li
- Shanghai United Imaging Intelligence, Co., Ltd., Shanghai, China
| | - Zheng Luo
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ruhui Xiao
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Bing Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jing Shi
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chen Zeng
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - BaiJinTao Sun
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaoxue Xu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hanfeng Yang
- The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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6
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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: 0] [Impact Index Per Article: 0] [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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7
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Rath TJ, Policeni B, Juliano AF, Agarwal M, Block AM, Burns J, Conley DB, Crowley RW, Dubey P, Friedman ER, Gule-Monroe MK, Hagiwara M, Hunt CH, Jain V, Powers WJ, Rosenow JM, Taheri MR, DuChene Thoma K, Zander D, Corey AS. ACR Appropriateness Criteria® Cranial Neuropathy: 2022 Update. J Am Coll Radiol 2022; 19:S266-S303. [PMID: 36436957 DOI: 10.1016/j.jacr.2022.09.021] [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: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Cranial neuropathy can result from pathology affecting the nerve fibers at any point and requires imaging of the entire course of the nerve from its nucleus to the end organ in order to identify a cause. MRI with and without intravenous contrast is often the modality of choice with CT playing a complementary role. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Tanya J Rath
- Division Chair of Neuroradiology, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Bruno Policeni
- Panel Chair; Department of Radiology Vice-Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa; President Iowa Radiological Society and ACR Councilor
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; NI-RADS committee chair
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin; Fellowship Program Director
| | - Alec M Block
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | - Judah Burns
- Montefiore Medical Center, Bronx, New York; Vice-Chair for Education & Residency Program Director, Montefiore Medical Center; Vice-Chair, Subcommittee on Methodology
| | - David B Conley
- Practice Director, Northwestern ENT and Rhinology Fellowship Director, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and Member, American Academy of Otolaryngology-Head and Neck Surgery
| | - R Webster Crowley
- Rush University Medical Center, Chicago, Illinois; Neurosurgery expert; Chief, Cerebrovascular and Endovascular Neurosurgery; Medical Director, Department of Neurosurgery; Surgical Director, Rush Comprehensive Stroke Center; Program Director, Endovascular Neurosurgery
| | | | - Elliott R Friedman
- University of Texas Health Science Center, Houston, Texas; Diagnostic Radiology Residency Program Director
| | - Maria K Gule-Monroe
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Medical Director of Diagnostic Imaging at Houston Area Location Woodlands
| | - Mari Hagiwara
- Neuroradiology Fellowship Program Director and Head and Neck Imaging Director, New York University Langone Medical Center, New York, New York
| | | | - Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio; Medical Director, Lumina Imaging
| | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology
| | - Joshua M Rosenow
- Neuroradiology Fellowship Program Director and Head and Neck Imaging Director, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia; Director of Neuroradiology
| | - Kate DuChene Thoma
- Director of Faculty Development Fellowship, University of Iowa Hospital, Iowa City, Iowa; Primary care physician
| | - David Zander
- Chief of Head and Neck Radiology, University of Colorado Denver, Denver, Colorado
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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Vardhan H, S S, N N, K S. Recurrent Trigeminal Neuralgia: A Case Series and a Review of the Literature. Cureus 2022; 14:e22548. [PMID: 35345688 PMCID: PMC8956785 DOI: 10.7759/cureus.22548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/05/2022] Open
Abstract
Trigeminal neuralgia is a peripheral neuropathy characterized by intermittent episodes of severe facial pain originating in the sensory nucleus of the trigeminal nerve. The most commonly involved area is the mandibular division with a higher prevalence on the right side. Advances in the field of MRI have played an important role in its diagnosis, especially in presurgical assessment, to probe into any secondary causes of nerve compression and/or neurovascular conflict. The condition is primarily managed medically, although many patients may require surgical or radiotherapeutic intervention. A recurrence rate ranging from 6 to 41% has been postulated. Reasons for recurrence are mainly attributed to improper operative techniques, dislocation of the Teflon implant, or granuloma formation. MRI serves as a powerful tool in the segmental evaluation of the trigeminal nerve. A proper diagnosis with a structured treatment protocol is critical for managing such cases of trigeminal neuralgia. In this report, we present a series of two cases of recurrent trigeminal neuralgia.
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Affiliation(s)
- Harsha Vardhan
- Oral Medicine and Radiology, Meenakshi Ammal Dental College, Chennai, IND
| | - Sushmitha S
- Faculty of Dentistry, Oral Medicine and Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Nagammai N
- Oral Medicine and Radiology, Meenakshi Ammal Dental College, Chennai, IND
| | - Saraswathi K
- Oral Medicine and Radiology, Meenakshi Ammal Dental College, Chennai, IND
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9
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Data fusion and 3D visualization for optimized representation of neurovascular relationships in the posterior fossa. Acta Neurochir (Wien) 2022; 164:2141-2151. [PMID: 35015156 PMCID: PMC9338141 DOI: 10.1007/s00701-021-05099-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/21/2021] [Indexed: 12/03/2022]
Abstract
Background Reliable 3D visualization of neurovascular relationships in the posterior fossa at the surface of the brainstem is still critical due to artifacts of imaging. To assess neurovascular compression syndromes more reliably, a new approach of 3D visualization based on registration and fusion of high-resolution MR data is presented. Methods A total of 80 patients received MRI data with 3D-CISS and 3D-TOF at 3.0 Tesla. After registration and subsequent segmentation, the vascular information of the TOF data was fused into the CISS data. Two 3D visualizations were created for each patient, one before and one after fusion, which were verified with the intraoperative situation during microvascular decompression (MVD). The reproduction quality of vessels was evaluated with a rating system. Results In all cases, the presented approach compensated for typical limitations in the 3D visualization of neurovascular compression such as the partial or complete suppression of larger vessels, suppression of smaller vessels at the CSF margin, and artifacts from heart pulsation. In more than 95% of the cases of hemifacial spasm and glossopharyngeal neuralgia, accurate assessment of the compression was only possible after registration and fusion. In more than 50% of the cases with trigeminal neuralgia, the presented approach was crucial to finding the actually offending vessel. Conclusions 3D visualization of fused image data allows for a more complete representation of the vessel-nerve situation. The results from this approach are reproducible and the assessment of neurovascular compression is safer. It is a powerful tool for planning MVD.
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Comparison of T2 Weighted, Fat-Suppressed T2 Weighted, and Three-Dimensional (3D) Fast Imaging Employing Steady-State Acquisition (FIESTA-C) Sequences in the Temporomandibular Joint (TMJ) Evaluation. BIOMED RESEARCH INTERNATIONAL 2022; 2021:6032559. [PMID: 34977244 PMCID: PMC8716192 DOI: 10.1155/2021/6032559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/20/2021] [Accepted: 11/29/2021] [Indexed: 12/03/2022]
Abstract
Aim Osteonecrosis can affect the mandibular condyle, and bone marrow edema may be a precursor in osteonecrosis development in temporomandibular disorder (TMD) patients. Early detection of bone marrow changes is crucial for occurring osteonecrosis. The purpose of this study was to compare the diagnostic value of fast spin-echo T2 weighted (FSE-T2W), fat-suppressed T2W (FS-T2W), and three-dimensional (3D) fast imaging employing steady-state acquisition (FIESTA-C) MR sequences for early detection of bone marrow changes as well as TMJ soft tissue alterations. Methods A total of 60 joints with TMD were included in this study using a 1.5T MR machine (Signa HDxt, GE, Milwaukee, USA) using a dual surface TMJ coil. Qualitatively, the images were interpreted by two observers for disk configuration, disk position, joint fluid, and bone marrow changes. Quantitatively, signal intensity ratios (SIR) in the TMJ condyle, retrodiscal tissue, disk, and muscle were also measured using all tested sequences. Kappa coefficients were calculated to assess both intra- and interobserver agreements for each image set. The SIR of each sequence was compared using a one-way ANOVA Bonferroni-Dunn test. Results Overall intraobserver kappa coefficients ranged between 0.35 and 0.88 for joint fluid and between 0.22 and 0.82 for bone marrow changes diagnosis, suggesting high intraobserver agreement for FS-T2W and 3D FIESTA-C sequences than FSE T2W sequence (p < 0.05). 3D FIESTA-C showed higher agreement values for disk configuration and position detection than other sequences. Conclusions 3D FIESTA-C sequences can be used and incorporated into routine MRI protocols for obtaining high-resolution TMJ MR images due to the short acquisition time and 3D nature of the sequence. Additional studies should be done for dynamic TMJ imaging with this sequence.
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11
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Lin J, Mou L, Yan Q, Ma S, Yue X, Zhou S, Lin Z, Zhang J, Liu J, Zhao Y. Automated Segmentation of Trigeminal Nerve and Cerebrovasculature in MR-Angiography Images by Deep Learning. Front Neurosci 2021; 15:744967. [PMID: 34955711 PMCID: PMC8702731 DOI: 10.3389/fnins.2021.744967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Trigeminal neuralgia caused by paroxysmal and severe pain in the distribution of the trigeminal nerve is a rare chronic pain disorder. It is generally accepted that compression of the trigeminal root entry zone by vascular structures is the major cause of primary trigeminal neuralgia, and vascular decompression is the prior choice in neurosurgical treatment. Therefore, accurate preoperative modeling/segmentation/visualization of trigeminal nerve and its surrounding cerebrovascular is important to surgical planning. In this paper, we propose an automated method to segment trigeminal nerve and its surrounding cerebrovascular in the root entry zone, and to further reconstruct and visual these anatomical structures in three-dimensional (3D) Magnetic Resonance Angiography (MRA). The proposed method contains a two-stage neural network. Firstly, a preliminary confidence map of different anatomical structures is produced by a coarse segmentation stage. Secondly, a refinement segmentation stage is proposed to refine and optimize the coarse segmentation map. To model the spatial and morphological relationship between trigeminal nerve and cerebrovascular structures, the proposed network detects the trigeminal nerve, cerebrovasculature, and brainstem simultaneously. The method has been evaluated on a dataset including 50 MRA volumes, and the experimental results show the state-of-the-art performance of the proposed method with an average Dice similarity coefficient, Hausdorff distance, and average surface distance error of 0.8645, 0.2414, and 0.4296 on multi-tissue segmentation, respectively.
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Affiliation(s)
- Jinghui Lin
- Department of Neurosurgery, Ningbo First Hospital, Ningbo, China
| | - Lei Mou
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Qifeng Yan
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Shaodong Ma
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Xingyu Yue
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Shengjun Zhou
- Department of Neurosurgery, Ningbo First Hospital, Ningbo, China
| | - Zhiqing Lin
- Department of Neurosurgery, Ningbo First Hospital, Ningbo, China
| | - Jiong Zhang
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Jiang Liu
- Department of Computer Science and Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Yitian Zhao
- The Affiliated People's Hospital of Ningbo University, Ningbo, China.,Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
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Label cleaning and propagation for improved segmentation performance using fully convolutional networks. Int J Comput Assist Radiol Surg 2021; 16:349-361. [PMID: 33655468 DOI: 10.1007/s11548-021-02312-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE In recent years, fully convolutional networks (FCNs) have been applied to various medical image segmentation tasks. However, it is difficult to generate a large amount of high-quality annotation data to train FCNs for medical image segmentation. Thus, it is desired to achieve high segmentation performances even from incomplete training data. We aim to evaluate performance of FCNs to clean noises and interpolate labels from noisy and sparsely given label images. METHODS To evaluate the label cleaning and propagation performance of FCNs, we used 2D and 3D FCNs to perform volumetric brain segmentation from magnetic resonance image volumes, based on network training on incomplete training datasets from noisy and sparse annotation. RESULTS The experimental results using pseudo-incomplete training data showed that both 2D and 3D FCNs could provide improved segmentation results from the incomplete training data, especially by using three orthogonal annotation images for network training. CONCLUSION This paper presented a validation for label cleaning and propagation based on FCNs. FCNs might have the potential to achieve improved segmentation performances even from sparse annotation data including possible noises by manual annotation, which can be an important clue to more efficient annotation.
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Zawy Alsofy S, Welzel Saravia H, Nakamura M, Ewelt C, Lewitz M, Sakellaropoulou I, Sarkis HM, Fortmann T, Schipmann S, Suero Molina E, Santacroce A, Salma A, Stroop R. Virtual reality-based evaluation of neurovascular conflict for the surgical planning of microvascular decompression in trigeminal neuralgia patients. Neurosurg Rev 2021; 44:3309-3321. [PMID: 33586035 DOI: 10.1007/s10143-021-01500-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/13/2020] [Accepted: 02/08/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is a lightning bolt of violent, electrifying, and stinging pain, often secondary to the neurovascular conflict (NVC). The vessels involved in NVC are mostly arteries and rarely veins. Evaluation of NVC in the deep infratentorial region is inseparably connected with cranial imaging. We retrospectively analyzed the potential influence of three-dimensional (3D) virtual reality (VR) reconstructions compared to conventional magnetic resonance imaging (MRI) scans on the evaluation of NVC for the surgical planning of microvascular decompression in patients with TN. METHODS Medical files were retrospectively analyzed regarding patient- and disease-related data. Preoperative MRI scans were retrospectively visualized via VR software to detect the characteristics of NVC. A questionnaire of experienced neurosurgeons evaluated the influence of VR visualization technique on identification of anatomical structures involved in NVC and on surgical strategy. RESULTS Twenty-four patients were included and 480 answer sheets were evaluated. Compared to conventional MRI, image presentation using 3D-VR modality significantly influenced the identification of the affected trigeminal nerve (p = 0.004), the vascular structure involved in the NVC (p = 0.0002), and the affected side of the trigeminal nerve (p = 0.005). CONCLUSIONS In patients with TN caused by NVC, the reconstruction of conventional preoperative MRI scans and the spatial and anatomical presentation in 3D-VR models offers the possibility of increased understanding of the anatomy and even more the underlying pathology, and thus influences operation planning and strategy.
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Affiliation(s)
- Samer Zawy Alsofy
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany. .,Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany.
| | - Heinz Welzel Saravia
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Makoto Nakamura
- Department of Neurosurgery, Academic Hospital Köln-Merheim, Witten/Herdecke University, Köln, Germany
| | - Christian Ewelt
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Marc Lewitz
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Ioanna Sakellaropoulou
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Hraq Mourad Sarkis
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | - Thomas Fortmann
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany
| | | | - Eric Suero Molina
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Antonio Santacroce
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Germany.,Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Germany
| | - Asem Salma
- Department of Neurosurgery, St. Rita's Neuroscience Institute, Lima, Ohio, USA
| | - Ralf Stroop
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Müller S, Khadhraoui E, Khanafer A, Psychogios M, Rohde V, Tanrikulu L. Differentiation of arterial and venous neurovascular conflicts estimates the clinical outcome after microvascular decompression in trigeminal neuralgia. BMC Neurol 2020; 20:279. [PMID: 32664930 PMCID: PMC7359280 DOI: 10.1186/s12883-020-01860-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Balanced Steady State Free Precession (b-SSFP) sequences and the newly developed Fast-Spin-Echo (FSE)-sequences enable an optimized visualization of neurovascular compression (NVC) in patients with trigeminal neuralgia (TN). Arterial conflicts are mostly associated with a favorable outcome of microvascular decompression (MVD) compared to venous conflicts. An additional Time-of-Flight (TOF) angiography provides the differentiation between offending arteries and veins and a precise counselling of the patient concerning postoperative pain relief. The goal of this study was to analyze the reliability and impact of the combination of highly-resoluted MRI techniques on the correct prediction of the vessel type and the estimation of postoperative outcome of microvascular decompression (MVD). METHODS In total, 48 patients (m/f: 32/16) underwent MVD for TN. All the preoperative imaging data (T2: b-SFFP and FSE, MRA: TOF) were compared to the intraoperative microsurgical findings during MVD. b-SFFP was available in 14 patients, FSE in 34 patients and an additional TOF sequence was available in 38 patients (9 times in combination with b-SSFP, 29 times in combination with FSE). The patients were categorized into four subgroups: 1) NVC negative, 2) venous NVC, 3) arterial NVC, 4) combined arterial and venous NVC. The preoperative MRI findings were compared to the intraoperative morphological findings. Postoperative pain relief was quantified by the Barrow Neurological Institute pain score. RESULTS Twenty-five purely arterial NVC, 9 purely venous NVC and 5 combined arterial and venous NVC were detected by MRI. In 9 cases NVC was absent on MRI. Overall, the MRI findings correctly predicted the intraoperative findings in 91.7% of the 48 patients. The percentage of correct prediction increased from 80 to 94.7%, when TOF angiography was adjoined. CONCLUSION The visualization of the trigeminal nerve using sequences such as b-SSFP or FSE in combination with TOF angiography enables an optimized delineation of arterial and venous neurovascular conflicts and may allow a more reliable differentiation between veins and arteries, resulting in superior prediction of postoperative pain relief compared to T2 imaging data alone.
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Affiliation(s)
- Sebastian Müller
- Departments of Neurosurgery, Georg-August-University Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.,Departments of Neuroradiology, Georg-August-University Goettingen, Göttingen, Germany
| | - Eya Khadhraoui
- Departments of Neuroradiology, Georg-August-University Goettingen, Göttingen, Germany
| | - Ali Khanafer
- Departments of Neuroradiology, Georg-August-University Goettingen, Göttingen, Germany
| | - Marios Psychogios
- Departments of Neuroradiology, Georg-August-University Goettingen, Göttingen, Germany
| | - Veit Rohde
- Departments of Neurosurgery, Georg-August-University Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Levent Tanrikulu
- Departments of Neurosurgery, Georg-August-University Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
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Wei SC, Yu R, Meng Q, Qu C. Efficacy of microvascular decompression in patients with trigeminal neuralgia with negative neurovascular relationship shown by magnetic resonance tomography. Clin Neurol Neurosurg 2020; 197:106063. [PMID: 32679513 DOI: 10.1016/j.clineuro.2020.106063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To explore the surgical efficacy of microvascular decompression(MVD) when the recent magnetic resonance tomography angiography(MRA) is unable to determine the relationship between blood vessels and nerves in patients with trigeminal neuralgia(TN). MATERIALS AND METHODS The MRI images of 146 patients with TN who underwent MVD from January 2016 to December 2019 were analyzed retrospectively. The relationship between nerves and vessels was categorized as no contact, suspicious contact, and clear contact. Suspicious contact and clear contact were both defined as positive neurovascular relationship, whereas no contact was defined as negative neurovascular relationship. The efficacy of MVD in positive and negative groups was compared. RESULTS 1. A total of 146 TN patients underwent MVD. Intraoperative examination revealed that out of 146, 143 patients exhibited contacts, including 110 cases with arterial contact, 22 cases with combined arterial and venous contact, and 11 cases with venous contact. Considering the surgical result as a gold standard, the sensitivity of three-dimensional time leap angiography (3D-TOF-MRA) in assessing vascular compression in TN was 74.0 %; and the sensitivity of three-dimensional steady-state precession rapid imaging sequence (3D-FIESTA) in determining vascular compression was 82.2 %. Out of a total of 17 cases demonstrating negative neurovascular relationship by 3D-TOF-MRA together with 3D-FIESTA, 14 cases were found to have vascular contact during the surgery, and the sensitivity was determined to be 88.4 %. 2.Among the 38 patients with a negative neurovascular relationship demonstrated by 3D-TOF, postoperative efficacy was noted as a cure: 30 cases, improved: 5 cases, no effect: 3 cases. 3D-FIESTA showed 26 cases of negative neurovascular relationship, among them, cured: 20 cases, improved: 3 cases, no effect: 3 cases. A total of 17 patients with negative neurovascular relationships were established by 3D-TOF-MRA together with 3D-FIESTA, and the postoperative effects were found to be cure: 13 cases, improvement: 2 cases, and no effect: 2 cases. There was no statistically significant difference between the negative group and the positive group (x2 test; p > 0.05). CONCLUSION To conclude, 3D-TOF-MRA, together with 3D-FIESTA, can illustrate the large blood vessels surrounding the trigeminal nerve efficiently, and determine whether it is the offending blood vessel. The interpretation would help reproduce the local anatomical spatial structure of the site before surgery, yet it is impossible to assess the peripheral anatomical relationship of the trigeminal nerve cistern comprehensively and accurately. This hints that a perfect prediction of the surgical effect of MVD is not possible at present. Thus, typical symptoms of TN are the most critical indicators for MVD surgery.
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Affiliation(s)
- Sheng Cheng Wei
- The Department of Neurosurgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province,250033, China.
| | - Rui Yu
- The Department of Neurosurgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province,250033, China.
| | - Qinghu Meng
- The Department of Neurosurgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province,250033, China.
| | - Chuncheng Qu
- The Department of Neurosurgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province,250033, China.
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Role of Fused Three-Dimensional Time-of-Flight Magnetic Resonance Angiography and 3-Dimensional T2-Weighted Imaging Sequences in Neurovascular Compression. World Neurosurg 2020; 133:e180-e186. [DOI: 10.1016/j.wneu.2019.08.190] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/23/2019] [Accepted: 08/24/2019] [Indexed: 12/31/2022]
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Liu D, Shi P, Li K, Guo Y, Liu X, Wang C, Liu Y, He B, Zhang X. Preoperative visualization of neurovascular contact with 3D-FIESTA combined with 3D-TOF MRA to guide microvascular decompression surgery planning. JOURNAL OF NEURORESTORATOLOGY 2020. [DOI: 10.26599/jnr.2020.9040005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Neurovascular compression syndromes including trigeminal neuralgia (TN) and hemifacial spasm (HFS) are caused by neurovascular conflicts at the root entry zone of the corresponding cranial nerves in the posterior fossa. Microvascular decompression (MVD) is the best choice for the treatment of TN and HFS. An accurate delineation of the responsible vessel could decrease the rate of possible operative complications such as nerve paresis. Methods: In this study, three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) and three-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA) were performed on 113 patients with TN or HFS. The imaging data were compared to the intraoperative findings and the accuracy of the data was calculated among the different responsible blood vessels and disease types. The accuracy of the data among different genders, disease durations, disease sides, and disease types was also calculated to identify the target patients for the preoperative diagnostic approach with 3D-FIESTA combined with 3D-TOF MRA. Results: The accuracy of detection with the imaging was above 75% in cases with single-vessel compression. Among these, the accuracy of the preoperative imaging result was the highest when the lesions were in the superior cerebellar artery (SCA; 91.1%). In cases of multiple-vessel compression, however, the coincidence between the preoperative and intraoperative results was only 30.0%. In most of the cases of TN, the responsible blood vessels were in the SCA, and the accuracy in the SCA reached 94.9%. In HFS patients, the responsible blood vessels were in the anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA), and the accuracy was 86.8% and 90.0%, respectively. The differences in the accuracy of the data among different genders, disease durations, disease sides, and disease types were not statistically significant. Conclusion: This study verified the clinical instructional value of 3D-FIESTA combined with 3D-TOF MRA in MVD, and showed that this preoperative examination is reliable for all genders, disease durations, disease sides, and disease types.
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Cleary DR, Handwerker J, Ansari H, Ben-Haim S. Three Cases of Trigeminal Neuralgia with Radiographic Absence of Meckel's Cave. Stereotact Funct Neurosurg 2019; 97:249-254. [PMID: 31661697 DOI: 10.1159/000502564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 08/08/2019] [Indexed: 11/19/2022]
Abstract
Trigeminal neuralgia (TN) is a debilitating but treatable disease. Classic TN has referable vascular compression of the trigeminal nerve, but rarely secondary sources of anatomic compression will present, including vascular malformations, aneurysms, or tumors. Understanding the etiology of the patients' symptoms leads to targeted treatment. Three patients presented with symptoms consistent with TN: shooting, paroxysmal pains in the distribution of the trigeminal nerve. However, imaging revealed no vascular conflict at the root entry zone of the trigeminal nerve. Instead, on the affected side Meckel's cave was absent. No other compressive mass lesion was identified. In all three cases, patients were offered both Gamma Knife Radiosurgery and surgical decompression of Meckel's cave. All 3 patients elected to proceed with stereotactic radiation and reported improvement in pain. Many cases of classic TN can be explained by neurovascular conflict at the trigeminal root entry zone, but secondary sources of compression or restriction along the nerve can result in similar symptomology. In this case series, an absent or hypoplastic ipsilateral Meckel's cave may have produced symptoms consistent with TN. Imaging with fine cuts through Meckel's cave is an important diagnostic tool.
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Affiliation(s)
- Daniel R Cleary
- Department of Neurological Surgery, University of California San Diego, San Diego, California, USA
| | - Jason Handwerker
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Hossein Ansari
- Department of Neurosciences, University of California San Diego, San Diego, California, USA
| | - Sharona Ben-Haim
- Department of Neurological Surgery, University of California San Diego, San Diego, California, USA,
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19
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Ruiz-Juretschke F, Guzmán-de-Villoria J, García-Leal R, Sañudo J. Predictive value of magnetic resonance imaging for identifying neurovascular compressions in trigeminal neuralgia. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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20
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Ruiz-Juretschke F, Guzmán-de-Villoria J, García-Leal R, Sañudo J. Valor predictivo de la resonancia magnética para la identificación de compresiones neurovasculares en la neuralgia del trigémino. Neurologia 2019; 34:510-519. [DOI: 10.1016/j.nrl.2017.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/12/2017] [Accepted: 03/26/2017] [Indexed: 01/03/2023] Open
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Raygor KP, Wang DD, Ward MM, Barbaro NM, Chang EF. Long-term pain outcomes for recurrent idiopathic trigeminal neuralgia after stereotactic radiosurgery: a prospective comparison of first-time microvascular decompression and repeat stereotactic radiosurgery. J Neurosurg 2018; 131:1207-1215. [PMID: 30485183 DOI: 10.3171/2018.5.jns172243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 05/02/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Microvascular decompression (MVD) and stereotactic radiosurgery (SRS) are common surgical treatments for trigeminal neuralgia (TN). Many patients who receive SRS have pain recurrence; the ideal second intervention is unknown. The authors directly compared pain outcomes after MVD and repeat SRS in a population of patients in whom SRS failed as their first-line procedure for TN, and they identified predictors of pain control. METHODS The authors reviewed a prospectively collected database of patients undergoing surgery for TN between 1997 and 2014 at the University of California, San Francisco (UCSF). Standardized data collection focused on preoperative clinical characteristics, surgical characteristics, and postoperative outcomes. Patients with typical type 1, idiopathic TN with ≥ 1 year of follow-up were included. RESULTS In total, 168 patients underwent SRS as their first procedure. Of these patients, 90 had residual or recurrent pain. Thirty of these patients underwent a second procedure at UCSF and had ≥ 1 year of follow-up; 15 underwent first-time MVD and 15 underwent repeat SRS. Patients undergoing MVD were younger than those receiving repeat SRS and were more likely to receive ≥ 80 Gy during the initial SRS. The average follow-up was 44.9 ± 33.6 months for MVD and 48.3 ± 45.3 months for SRS. All patients achieved complete pain freedom without medication at some point during their follow-up. At last follow-up, 80% of MVD-treated patients and 33.3% of SRS-treated patients had a favorable outcome, defined as Barrow Neurological Institute Pain Intensity scores of I-IIIa (p < 0.05). Percentages of patients with favorable outcome at 1 and 5 years were 86% and 75% for the MVD cohort and 73% and 27% for the SRS cohort, respectively (p < 0.05). Multivariate Cox proportional hazards analysis demonstrated that performing MVD was statistically significantly associated with favorable outcome (HR 0.12, 95% CI 0.02-0.60, p < 0.01). There were no statistically significant predictors of favorable outcome in the MVD cohort; however, the presence of sensory changes after repeat SRS was associated with pain relief (p < 0.01). CONCLUSIONS Patients who received MVD after failed SRS had a longer duration of favorable outcome compared to those who received repeat SRS; however, both modalities are safe and effective. The presence of post-SRS sensory changes was predictive of a favorable pain outcome in the SRS cohort.
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Affiliation(s)
- Kunal P Raygor
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Doris D Wang
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Mariann M Ward
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Nicholas M Barbaro
- 2Department of Neurological Surgery, Indiana University, Indianapolis, Indiana
| | - Edward F Chang
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
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22
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Jani RH, Hughes MA, Ligus ZE, Nikas A, Sekula RF. MRI Findings and Outcomes in Patients Undergoing Microvascular Decompression for Glossopharyngeal Neuralgia. J Neuroimaging 2018; 28:477-482. [PMID: 30102011 DOI: 10.1111/jon.12554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/23/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Glossopharyngeal neuralgia causes extreme paroxysmal pain in the posterior pharynx, tonsillar region, base of tongue, or deep ear, that is, the distribution of the glossopharyngeal nerve. Some cases of glossopharyngeal neuralgia are associated with neurovascular conflict, usually by the posterior inferior cerebellar artery. Such symptomatic compression occurs only in proximal, centrally myelinated portions of the glossopharyngeal nerve near the brainstem. Microvascular decompression provides effective and durable pain relief for properly selected patients with medically refractory glossopharyngeal neuralgia. The purpose of this study is to describe a tailored MRI evaluation of neurovascular conflict in glossopharyngeal neuralgia to improve candidate selection for microvascular decompression. METHODS Our team developed a glossopharyngeal neuralgia imaging and evaluation protocol including a grading system for neurovascular conflict of the glossopharyngeal nerve and applied it to evaluate candidates for microvascular decompression. RESULTS Our team grades neurovascular conflict as "contact" (vessel touching nerve without intervening cerebrospinal fluid) versus "deformation" (deviation or distortion of nerve from its normal course by the offending vessel). MRIs of patients with glossopharyngeal neuralgia demonstrate proximal neurovascular conflict. Postoperative MRI demonstrates separation of the glossopharyngeal nerve from the offending vessel. CONCLUSION A tailored glossopharyngeal neuralgia imaging evaluation protocol is presented. We believe this approach has helped improve microvascular decompression outcomes and reduce unnecessary procedures at our institution. Further research may elucidate whether clinical and imaging features, including neurovascular conflict severity, predict surgical outcome for glossopharyngeal neuralgia.
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Affiliation(s)
- Ronak H Jani
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marion A Hughes
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Radiology, Pittsburgh, Pennsylvania, USA
| | - Zachary E Ligus
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alexandra Nikas
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Raymond F Sekula
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Neurological Surgery, Pittsburgh, Pennsylvania, USA
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Khaku A, Patel V, Zacharia T, Goldenberg D, McGinn J. Guidelines for radiographic imaging of cranial neuropathies. EAR, NOSE & THROAT JOURNAL 2018; 96:E23-E39. [PMID: 29121382 DOI: 10.1177/0145561317096010-1106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Disruption of the complex pathways of the 12 cranial nerves can occur at any site along their course, and many, varied pathologic processes may initially manifest as dysfunction and neuropathy. Radiographic imaging (computed topography or magnetic resonance imaging) is frequently used to evaluate cranial neuropathies; however, indications for imaging and imaging method of choice vary considerably between the cranial nerves. The purpose of this review is to provide an analysis of the diagnostic yield and the most clinically appropriate means to evaluate cranial neuropathies using radiographic imaging. Using the PubMed MEDLINE NCBI database, a total of 49,079 articles' results were retrieved on September 20, 2014. Scholarly articles that discuss the etiology, incidence, and use of imaging in the context of evaluation and diagnostic yield of the 12 cranial nerves were evaluated for the purposes of this review. We combined primary research, guidelines, and best practice recommendations to create a practical framework for the radiographic evaluation of cranial neuropathies.
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Affiliation(s)
- Aliasgher Khaku
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, 500 University Dr., MC H091, Hershey, PA 17033-0850, USA
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Ruiz‐Juretschke F, González‐Quarante LH, García‐Leal R, Martínez de Vega V. Neurovascular Relations of the Trigeminal Nerve in Asymptomatic Individuals Studied with High‐Resolution Three‐Dimensional Magnetic Resonance Imaging. Anat Rec (Hoboken) 2018; 302:639-645. [PMID: 29659161 DOI: 10.1002/ar.23818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/04/2017] [Accepted: 04/16/2017] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Roberto García‐Leal
- Department of NeurosurgeryHospital General Universitario “Gregorio Marañón”Madrid Spain
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Yang D, Shen J, Xia X, Lin Y, Yang T, Lin H, Jin Y, Zhou K, Li Y. Preoperative evaluation of neurovascular relationship in trigeminal neuralgia by three-dimensional fast low angle shot (3D-FLASH) and three-dimensional constructive interference in steady-state (3D-CISS) MRI sequence. Br J Radiol 2018; 91:20170557. [PMID: 29388798 DOI: 10.1259/bjr.20170557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The purpose of the study was to evaluate the value of high-resolution three-dimensional fast low angle shot (3D-FLASH) and three-dimensional constructive interference in steady-state (3D-CISS) MRI sequence solely or the combination of both in the visualization of neurovascular relationship in patients with trigeminal neuralgia (TN). METHODS 65 patients with unilateral TN underwent 3D-FLASH and 3D-CISS imaging were retrospectively studied. Neurovascular relationship at the intracisternal segment of trigeminal nerve was reviewed by two experienced neuroradiologist, who was blinded to the clinical details. The imaging results were compared with the operative findings in all patients. RESULTS The accuracy and positive rates of the 3D-FLASH + CISS imaging (98.46, 92.31%) in judging the symptomatic side according to the presence of vascular contacts were higher than those of 3D-CISS (90.77%, 84.62) or 3D-FLASH (89.23, 83.08%) sequence. In addition, the statistical analysis showed the sensitivity and accuracy of 3D-FLASH + CISS imaging was higher than that of 3D-FLASH (p < 0.05). The 3D-FLASH + CISS imaging was more accurate in determining the type of offending vessel than 3D-CISS or 3D-FLASH imaging. CONCLUSION The retrospective study demonstrates that the combination of 3D-FLASH with 3D-CISS sequence well delineates the relationship between intracisternal segment of trigeminal nerve and adjacent vessels in terms of increased positive rates and accuracy. Advances in knowledge: The study firstly dealt with the combination of 3D-CISS and 3D-FLASH imaging in TN.
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Affiliation(s)
- Dengfa Yang
- 1 Department of Radiology, Taizhou Municipal Hospital , Taizhou, Zhejiang , China
| | - Jianmin Shen
- 1 Department of Radiology, Taizhou Municipal Hospital , Taizhou, Zhejiang , China
| | - Xianwu Xia
- 1 Department of Radiology, Taizhou Municipal Hospital , Taizhou, Zhejiang , China
| | - Yeqing Lin
- 1 Department of Radiology, Taizhou Municipal Hospital , Taizhou, Zhejiang , China
| | - Tiejun Yang
- 1 Department of Radiology, Taizhou Municipal Hospital , Taizhou, Zhejiang , China
| | - Hanshun Lin
- 1 Department of Radiology, Taizhou Municipal Hospital , Taizhou, Zhejiang , China
| | - Yong Jin
- 2 Department of Neurological Surger, Taizhou Municipal Hospital , Taizhou, Zhejiang , China
| | - Kaiyu Zhou
- 2 Department of Neurological Surger, Taizhou Municipal Hospital , Taizhou, Zhejiang , China
| | - Youcheng Li
- 3 Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University , Wenzhou, Zhejiang , China
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Policeni B, Corey AS, Burns J, Conley DB, Crowley RW, Harvey HB, Hoang J, Hunt CH, Jagadeesan BD, Juliano AF, Kennedy TA, Moonis G, Pannell JS, Patel ND, Perlmutter JS, Rosenow JM, Schroeder JW, Whitehead MT, Cornelius RS. ACR Appropriateness Criteria ® Cranial Neuropathy. J Am Coll Radiol 2017; 14:S406-S420. [DOI: 10.1016/j.jacr.2017.08.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/09/2023]
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Jung HH, Park CK, Jung NY, Kim M, Chang WS, Chang JW. Gamma Knife Radiosurgery for Idiopathic Trigeminal Neuralgia: Does the Status of Offending Vessels Influence Pain Control or Side Effects? World Neurosurg 2017; 104:687-693. [PMID: 28532912 DOI: 10.1016/j.wneu.2017.05.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 05/09/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate pain control and side effects after gamma knife radiosurgery (GKRS) for classical idiopathic trigeminal neuralgia (TN) with or without neurovascular compression (NVC). METHODS This study included 47 patients with type 1 idiopathic TN and Barrow Neurological Institute (BNI) pain class IV or V who were treated with GKRS, with a maximum dose of 85 Gy targeting the root entry zone, as an initial treatment modality between January 2005 and March 2015. A retrospective analysis of NVC status, pain control, side effects, recurrence, and cross-sectional area was conducted. RESULTS During follow-up (median, 21.5 months; range, 3-119 months), 36 of the 47 patients (76.6%) demonstrated good outcomes (i.e., improved to below BNI class IIIa). Twenty-two patients did not have NVC (group A) and 25 had NVC (group B). The rate of good outcomes did not differ significantly between the 2 groups (group A, 86.4% [19 of 22] vs. group B, 68% [17 of 25]; P = 0.138). The number of cases in BNI class I or II and the number of recurrences also did not differ significantly between the 2 groups (P = 0.532 and 0.786, respectively). The mean area was 8.64 ± 2.59 mm3 in nondeviated cases (n = 27) and 2.59 ± 1.68 mm3 in deviated (n = 10). Side effects were significantly more frequent in deviated cases (80% [8 of 10]) than in nondeviated cases (25.9% [7 of 27]; P = 0.003). CONCLUSIONS NVC is not a predictive factor for pain control after GKRS for the treatment of idiopathic TN. Side effects may occur more frequently in patients with NVC at the target coordinate when a root entry zone is used, but the subjective symptoms are not always bothersome.
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Affiliation(s)
- Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Kyu Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Na Young Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Minsoo Kim
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Abstract
Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Type 1 as intermittent and Type 2 as constant pain represent distinct clinical, pathological, and prognostic entities. Although multiple mechanism involving peripheral pathologies at root (compression or traction), and dysfunctions of brain stem, basal ganglion, and cortical pain modulatory mechanisms could have role, neurovascular conflict is the most accepted theory. Diagnosis is essentially clinically; magnetic resonance imaging is useful to rule out secondary causes, detect pathological changes in affected root and neurovascular compression (NVC). Carbamazepine is the drug of choice; oxcarbazepine, baclofen, lamotrigine, phenytoin, and topiramate are also useful. Multidrug regimens and multidisciplinary approaches are useful in selected patients. Microvascular decompression is surgical treatment of choice in TN resistant to medical management. Patients with significant medical comorbidities, without NVC and multiple sclerosis are generally recommended to undergo gamma knife radiosurgery, percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation procedures. Partial sensory root sectioning is indicated in negative vessel explorations during surgery and large intraneural vein. Endoscopic technique can be used alone for vascular decompression or as an adjuvant to microscope. It allows better visualization of vascular conflict and entire root from pons to ganglion including ventral aspect. The effectiveness and completeness of decompression can be assessed and new vascular conflicts that may be missed by microscope can be identified. It requires less brain retraction.
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Affiliation(s)
- Yad Ram Yadav
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Yadav Nishtha
- Department of Radio Diagnosis and Imaging, All India Institute of Medical Science, New Delhi, India
| | - Pande Sonjjay
- Department of Radio Diagnosis and Imaging, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Parihar Vijay
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Ratre Shailendra
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Khare Yatin
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
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Presurgical visualization of the neurovascular relationship in trigeminal neuralgia with 3D modeling using free Slicer software. Acta Neurochir (Wien) 2016; 158:2195-2201. [PMID: 27543280 DOI: 10.1007/s00701-016-2936-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/11/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To explore whether segmentation and 3D modeling are more accurate in the preoperative detection of the neurovascular relationship (NVR) in patients with trigeminal neuralgia (TN) compared to MRI fast imaging employing steady-state acquisition (FIESTA). METHOD Segmentation and 3D modeling using 3D Slicer were conducted for 40 patients undergoing MRI FIESTA and microsurgical vascular decompression (MVD). The NVR, as well as the offending vessel determined by MRI FIESTA and 3D Slicer, was reviewed and compared with intraoperative manifestations using SPSS. RESULTS The k agreement between the MRI FIESTA and operation in determining the NVR was 0.232 and that between the 3D modeling and operation was 0.6333. There was no significant difference between these two procedures (χ2 = 8.09, P = 0.088). The k agreement between the MRI FIESTA and operation in determining the offending vessel was 0.373, and that between the 3D modeling and operation was 0.922. There were significant differences between two of them (χ2 = 82.01, P = 0.000). The sensitivity and specificity for MRI FIESTA in determining the NVR were 87.2 % and 100 %, respectively, and for 3D modeling were both 100 %. CONCLUSION The segmentation and 3D modeling were more accurate than MRI FIESTA in preoperative verification of the NVR and offending vessel. This was consistent with surgical manifestations and was more helpful for the preoperative decision and surgical plan.
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Salma A, Alkhani A, Akil H. Letter to the Editor: Trigeminal neuralgia in patients with multiple sclerosis. J Neurosurg 2016; 125:237-8. [DOI: 10.3171/2016.3.jns16565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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MRI of the Trigeminal Nerve in Patients With Trigeminal Neuralgia Secondary to Vascular Compression. AJR Am J Roentgenol 2016; 206:595-600. [PMID: 26901017 DOI: 10.2214/ajr.14.14156] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Trigeminal neuralgia is a debilitating facial pain disorder, frequently caused by vascular compression of the trigeminal nerve. Vascular compression that results in trigeminal neuralgia occurs along the cisternal segment of the nerve. CONCLUSION Imaging combined with clinical information is critical to correctly identify patients who are candidates for microvascular decompression. The purpose of this article is to review trigeminal nerve anatomy and to provide strategies for radiologists to recognize important MRI findings in patients with trigeminal neuralgia.
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Wang Y, Li D, Bao F, Guo C, Ma S, Zhang M. Microstructural abnormalities of the trigeminal nerve correlate with pain severity and concomitant emotional dysfunctions in idiopathic trigeminal neuralgia: A randomized, prospective, double-blind study. Magn Reson Imaging 2016; 34:609-16. [DOI: 10.1016/j.mri.2015.11.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/12/2015] [Accepted: 11/29/2015] [Indexed: 12/20/2022]
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Thieme V. Orofazialer Schmerz - Trigeminusneuralgie und posttraumatische Trigeminusneuropathie. Schmerz 2016; 30:99-117. [DOI: 10.1007/s00482-016-0097-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Ruiz-Juretschke F, Vargas A, González-Rodrigalvarez R, Garcia-Leal R. Hemifacial spasm caused by a cerebellopontine angle arachnoid cyst. Case report and literature review. Neurocirugia (Astur) 2015; 26:307-10. [PMID: 26165486 DOI: 10.1016/j.neucir.2015.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 04/29/2015] [Accepted: 05/03/2015] [Indexed: 10/23/2022]
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Diagnostic value of 3D time-of-flight MRA in trigeminal neuralgia. J Clin Neurosci 2015; 22:1343-8. [DOI: 10.1016/j.jocn.2015.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/30/2015] [Accepted: 02/04/2015] [Indexed: 12/15/2022]
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Ibrahim TF, Garst JR, Burkett DJ, Toia GV, Braca JA, Hill JP, Anderson DE. Microsurgical Pontine Descending Tractotomy in Cases of Intractable Trigeminal Neuralgia. Oper Neurosurg (Hagerstown) 2015; 11:518-529. [DOI: 10.1227/neu.0000000000000926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 06/22/2015] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Current treatment strategies in patients with trigeminal neuralgia (TN) include trials of medical therapy and surgical intervention, when necessary. In some patients, pain is not adequately managed with these existing strategies.
OBJECTIVE
To present a novel technique, ventral pontine trigeminal tractotomy via retrosigmoid craniectomy, as an adjunct treatment in TN when there is no significant neurovascular compression.
METHODS
We present a nonrandomized retrospective comparison between 50 patients who lacked clear or impressive arterial neurovascular compression of the trigeminal nerve as judged by preoperative magnetic resonance imaging and intraoperative observations. These patients had intractable TN unresponsive to previous treatment. Trigeminal tractotomy was performed either alone or in conjunction with microvascular decompression. Stereotactic neuronavigation was used during surgery to localize the descending tract via a ventral pontine approach for descending tractotomy.
RESULTS
Follow-up was a mean of 44 months. At first follow-up, 80% of patients experienced complete relief of their pain, and 18% had partial relief. At the most recent follow-up, 74% of patients were considered a successful outcome. Only 1 (2%) patient had no relief after trigeminal tractotomy. Of those with multiple sclerosis-related TN, 87.5% experienced successful relief of pain at their latest follow-up.
CONCLUSION
While patient selection is a significant challenge, this procedure represents an option for patients with TN who have absent or equivocal neurovascular compression, multiple sclerosis-related TN, or recurrent TN.
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Affiliation(s)
- Tarik F Ibrahim
- Department of Neurological Surgery at Loyola University Chicago, Health Sciences Campus, Stritch School of Medicine, Maywood, Illinois
| | - Jonathan R Garst
- Department of Neurological Surgery at Loyola University Chicago, Health Sciences Campus, Stritch School of Medicine, Maywood, Illinois
| | - Daniel J Burkett
- Department of Neurological Surgery at Loyola University Chicago, Health Sciences Campus, Stritch School of Medicine, Maywood, Illinois
| | - Giuseppe V Toia
- Department of Neurological Surgery at Loyola University Chicago, Health Sciences Campus, Stritch School of Medicine, Maywood, Illinois
| | - John A Braca
- Department of Neurological Surgery at Loyola University Chicago, Health Sciences Campus, Stritch School of Medicine, Maywood, Illinois
| | - Jacquelyn P Hill
- Department of Neurological Surgery at Loyola University Chicago, Health Sciences Campus, Stritch School of Medicine, Maywood, Illinois
| | - Douglas E Anderson
- Department of Neurological Surgery at Loyola University Chicago, Health Sciences Campus, Stritch School of Medicine, Maywood, Illinois
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Duan Y, Sweet J, Munyon C, Miller J. Degree of distal trigeminal nerve atrophy predicts outcome after microvascular decompression for Type 1a trigeminal neuralgia. J Neurosurg 2015; 123:1512-8. [PMID: 26186027 DOI: 10.3171/2014.12.jns142086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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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Affiliation(s)
- Yifei Duan
- Case Western Reserve University School of Medicine; and
| | - Jennifer Sweet
- Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Charles Munyon
- Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Jonathan Miller
- Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
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Montano N, Conforti G, Di Bonaventura R, Meglio M, Fernandez E, Papacci F. Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag 2015; 11:289-99. [PMID: 25750533 PMCID: PMC4348120 DOI: 10.2147/tcrm.s37592] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
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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Affiliation(s)
| | | | | | - Mario Meglio
- Institute of Neurosurgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Fabio Papacci
- Institute of Neurosurgery, Catholic University, Rome
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Cheng JS, Lim DA, Chang EF, Barbaro NM. A review of percutaneous treatments for trigeminal neuralgia. Neurosurgery 2014; 10 Suppl 1:25-33; discussion 33. [PMID: 24509496 DOI: 10.1227/neu.00000000000001687] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Common treatments for trigeminal neuralgia include percutaneous techniques, microvascular decompression, and Gamma Knife radiosurgery. Although microvascular decompression is considered the gold standard for treatment, percutaneous techniques remain an effective option for select patients. OBJECTIVE To review the historical development, advantages, and limitations of the most common percutaneous procedures for trigeminal neuralgia: balloon compression (BC), glycerol rhizotomy (GR), and radiofrequency thermocoagulation (RF). METHODS Publications reporting clinical outcomes after BC, GR, and RF were reviewed and included. Operative technique was based on the experience of the primary surgeon and senior author. RESULTS All 3 percutaneous techniques (BC, GR, and RF) provide effective pain relief but differ in method and specificity of nerve injury. BC selectively injures larger pain fibers while sparing small fibers and does not require an awake, cooperative patient. Pain control rates up to 91% at 6 months and 66% at 3 years have been reported. RF allows somatotopic nerve mapping and selective division lesioning and provides pain relief in up to 97% of patients initially and 58% at 5 years. Multiple treatments improve outcomes but carry significant morbidity risk. GR offers similar pain-free outcomes of 90% at 6 months and 54% at 3 years but with higher complication rates (25% vs. 16%) compared with BC. Advantages of percutaneous techniques include shorter procedure duration, minimal anesthesia risk, and in the case of GR and RF, immediate patient feedback. CONCLUSION Percutaneous treatments for trigeminal neuralgia remain safe, simple, and effective for achieving good pain control while minimizing procedural risk.
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Affiliation(s)
- Jason S Cheng
- *Department of Neurological Surgery, ‡Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, and §Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, California; ¶Department of Neurological Surgery, Indiana University School of Medicine, and Goodman Campbell Brain and Spine, Indianapolis, Indiana
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40
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Abstract
Trigeminal neuralgia and glossopharyngeal neuralgia are two causes of paroxysmal craniofacial pain. Either can be debilitating in affected individuals. This article reviews the epidemiology, pathogenesis, diagnosis, and treatment options for these disorders.
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Affiliation(s)
- Gaddum Duemani Reddy
- Department of Neurosurgery, Baylor College of Medicine, 1709 Dryden Street, Houston, TX 77030, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, 1709 Dryden Street, Houston, TX 77030, USA.
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Hendrix P, Griessenauer CJ, Foreman P, Loukas M, Fisher WS, Rizk E, Shoja MM, Tubbs RS. Arterial supply of the lower cranial nerves: A comprehensive review. Clin Anat 2013; 27:108-17. [DOI: 10.1002/ca.22318] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 08/08/2013] [Accepted: 08/11/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Philipp Hendrix
- Division of Neurosurgery; Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Christoph J. Griessenauer
- Division of Neurosurgery; Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Paul Foreman
- Division of Neurosurgery; Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Marios Loukas
- Department of Anatomical Sciences; St. George's University; Grenada
| | - Winfield S. Fisher
- Division of Neurosurgery; Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Elias Rizk
- Pediatric Neurosurgery; Children's Hospital; Birmingham Alabama
| | | | - R. Shane Tubbs
- Department of Anatomical Sciences; St. George's University; Grenada
- Pediatric Neurosurgery; Children's Hospital; Birmingham Alabama
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Sandel T, Eide PK. Long-term results of microvascular decompression for trigeminal neuralgia and hemifacial spasms according to preoperative symptomatology. Acta Neurochir (Wien) 2013; 155:1681-92; discussion 1692. [PMID: 23873123 DOI: 10.1007/s00701-013-1816-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/03/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Microvascular decompression (MVD) is currently used in several centres for the treatment of trigeminal neuralgia (TN) and hemifacial spasms (HFS). How long-term results relate to the preoperative symptoms still needs to be documented. The primary aim of this study was to assess long-term results of MVD for TN and HFS, as related to the types of preoperative symptoms. METHODS We performed a retrospective study including all first-time MVDs for TN and HFS done during the 11-year period (1999-2009) in the Department of Neurosurgery, The National Hospital (Rikshospitalet), Oslo. The patients were categorized depending on the pre-operative symptomatology. RESULTS The study population includes 303 first-time procedures performed by the senior author (PKE), 243 TN patients (65 % TN without constant pain and 35 % TN with constant pain) and 60 HFS patients (95 % typical HFS and 5 % atypical HFS). The patients were followed for a mean 71 months (range, 14-147). In both the TN and HFS patients, MVD caused lasting symptom relief in a high proportion of patients, including patients with atypical symptoms. CONCLUSION After MVD for TN and HFS, regardless of preoperative symptoms, lasting relief is observed in a high proportion of patients, with a favorable complication profile.
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Affiliation(s)
- Tiril Sandel
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Pb 4950, Nydalen, 0424, Oslo, Norway
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Wang QJ, Guo Y, Zhang Y, Hu YY, Li WP, Lu W, Lin W. 3D MRI of oculomotor nerve schwannoma in the prepontine cistern: a case report. Clin Imaging 2013; 37:947-9. [PMID: 23845257 DOI: 10.1016/j.clinimag.2013.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 06/04/2013] [Indexed: 11/18/2022]
Abstract
Oculomotor nerve schwannoma is an extremely rare tumor. Only less than 40 cases have been reported in the literature. We report the case of a small oculomotor nerve schwannoma arising from the prepontine cistern in a 30-year-old man with a long-time ophthalmoplegic migraine. The spatial relationship of the tumor, oculomotor nerve, and surrounding arteries was clearly demonstrated by using three three-dimensional magnetic resonance imaging sequences.
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Affiliation(s)
- Qing-jun Wang
- Department of Radiology, Chinese Navy General Hospital of PLA, Fucheng Road, Beijing 100037, China.
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