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The practical limits of high-quality magnetic resonance imaging for the diagnosis and classification of trigeminal neuralgia. Clin Neurol Neurosurg 2022; 221:107403. [PMID: 35933966 DOI: 10.1016/j.clineuro.2022.107403] [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: 06/25/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Neurovascular compression (NVC) has been the primary hypothesis for the underlying mechanism of classical trigeminal neuralgia (TN). However, a substantial body of literature has emerged highlighting notable exceptions to this hypothesis. The purpose of this study is to assess the reliability and diagnostic accuracy of high resolution, high contrast MRI-determined neurovascular contact for TN. METHODS We performed a retrospective, randomized, and blinded parallel characterization of neurovascular interaction and diagnosis in a population of TN patients and controls using four expert reviewers. Performance statistics were calculated, as well as assessments for generalizability using shuffled bootstraps. RESULTS Fair to moderate agreement (ICC: 0.32-0.68) about diagnosis between reviewers was observed using MRIs from 47 TN patients and 47 controls. On average reviewers performed no better than chance when diagnosing participants, with an accuracy of 0.57 (95% CI 0.40, 0.59) per patient. CONCLUSION While MRI is useful in determining structural causes in secondary TN, expert reviewers do no better to only slightly better than chance with distinguishing TN with MRI, despite moderate agreement. Further, the causal role of NVC for TN is not clear, limiting the applicability of MRI to diagnose or prognosticate treatment of TN.
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The anterior one third of the posterior limb of the internal capsule is also supplied by the anterior choroidal artery. J Neurol Sci 2019; 406:116455. [PMID: 31634717 DOI: 10.1016/j.jns.2019.116455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/30/2019] [Accepted: 09/09/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE It is universally recognized that the anterior choroidal artery (AChA) supplies the posterior two-third of the posterior limb of internal capsule (PLIC). On the other hand, the blood supply to the anterior one third of the PLIC has remained undetermined. We posit the anterior one third of the PLIC is also supplied by the AChA referring the previous microsurgical descriptions. METHODS Ninety consecutive patients with isolated acute infarction in the PLIC were studied. We classified patients into 4 groups. 1. The anterior type that involved the anterior one-third part of the PLIC. 2. The posterior type that involved the caudal two-third part of the PLIC, 3. The combined type that located in the full length of the PLIC, 4. The dot type that restricted within PLIC up to10mm in diameter. RESULTS Patient numbers in groups 1 through 4 were 7 (7.7%), 46 (51.1%), 9 (10.6%) and 28 (31.1%). The anterior type involved the medial part of pallidum (MPP) in 5 patients (71.4%) and none in the lateral thalamus (LT), while the posterior type involved MPP only in 6 patients (13.0%) and LT in 33 patients (71.7%). CONCLUSION Corresponding to previous microsurgical descriptions, an occlusion of the proximal branches may cause anterior type infarct and that of the distal branches may cause posterior type infarcts. The anterior one third of the PLIC is also supplied by the branches of the AChA, albeit the low prevalence.
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Tanaka T, Shiiba S, Yoshino N, Harano N, Sago T, Kito S, Matsumoto-Takeda S, Wakasugi-Sato N, Oda M, Joujima T, Miyamura Y, Imamura Y, Morimoto Y. Predicting the therapeutic effect of carbamazepine in trigeminal neuralgia by analysis of neurovascular compression utilizing magnetic resonance cisternography. Int J Oral Maxillofac Surg 2019; 48:480-487. [DOI: 10.1016/j.ijom.2018.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/21/2018] [Accepted: 09/27/2018] [Indexed: 11/24/2022]
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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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Nakaura T, Iyama Y, Kidoh M, Yokoyama K, Oda S, Tokuyasu S, Harada K, Yamashita Y. Comparison of iterative model, hybrid iterative, and filtered back projection reconstruction techniques in low-dose brain CT: impact of thin-slice imaging. Neuroradiology 2015; 58:245-51. [PMID: 26715558 DOI: 10.1007/s00234-015-1631-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 12/07/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the utility of iterative model reconstruction (IMR) in brain CT especially with thin-slice images. METHODS This prospective study received institutional review board approval, and prior informed consent to participate was obtained from all patients. We enrolled 34 patients who underwent brain CT and reconstructed axial images with filtered back projection (FBP), hybrid iterative reconstruction (HIR) and IMR with 1 and 5 mm slice thicknesses. The CT number, image noise, contrast, and contrast noise ratio (CNR) between the thalamus and internal capsule, and the rate of increase of image noise in 1 and 5 mm thickness images between the reconstruction methods, were assessed. Two independent radiologists assessed image contrast, image noise, image sharpness, and overall image quality on a 4-point scale. RESULTS The CNRs in 1 and 5 mm slice thickness were significantly higher with IMR (1.2 ± 0.6 and 2.2 ± 0.8, respectively) than with FBP (0.4 ± 0.3 and 1.0 ± 0.4, respectively) and HIR (0.5 ± 0.3 and 1.2 ± 0.4, respectively) (p < 0.01). The mean rate of increasing noise from 5 to 1 mm thickness images was significantly lower with IMR (1.7 ± 0.3) than with FBP (2.3 ± 0.3) and HIR (2.3 ± 0.4) (p < 0.01). There were no significant differences in qualitative analysis of unfamiliar image texture between the reconstruction techniques. CONCLUSION IMR offers significant noise reduction and higher contrast and CNR in brain CT, especially for thin-slice images, when compared to FBP and HIR.
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Affiliation(s)
- Takeshi Nakaura
- Diagnostic Radiology, Amakusa Medical Center, Kameba 854-1, Amakusa, Kumamoto, 863-0046, Japan. .,Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Yuji Iyama
- Diagnostic Radiology, Amakusa Medical Center, Kameba 854-1, Amakusa, Kumamoto, 863-0046, Japan.,Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masafumi Kidoh
- Diagnostic Radiology, Amakusa Medical Center, Kameba 854-1, Amakusa, Kumamoto, 863-0046, Japan.,Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Yokoyama
- Diagnostic Radiology, Amakusa Medical Center, Kameba 854-1, Amakusa, Kumamoto, 863-0046, Japan.,Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Kazunori Harada
- Department of Surgery, Amakusa Medical Center, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Tanrikulu L, Scholz T, Nikoubashman O, Wiesmann M, Clusmann H. Preoperative MRI in neurovascular compression syndromes and its role for microsurgical considerations. Clin Neurol Neurosurg 2015; 129:17-20. [DOI: 10.1016/j.clineuro.2014.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 10/30/2014] [Accepted: 11/09/2014] [Indexed: 10/24/2022]
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Can the neurovascular compression volume of the trigeminal nerve on magnetic resonance cisternography predict the success of local anesthetic block after initial treatment by the carbamazepine? Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 117:e15-21. [PMID: 22925627 DOI: 10.1016/j.oooo.2012.03.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 03/10/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Whether NVC volume on magnetic resonance (MR) cisternography might be related to the success of local anesthetic block by tetracaine (TNB) as an additional treatment after carbamazepine (CBZ) treatments in patients with trigeminal neuralgia (TN) was evaluated. STUDY DESIGN Detectable NVC volumes were measured from MR cisternography in 65 patients with TN treated by TNB after CBZ treatments. The correlation between the success of TNB and the NVC volume or the improvement in pain by CBZ was evaluated retrospectively. RESULTS A significant difference was found between the improvement in pain by CBZ and the success of TNB, but not between NVC volume on MR cisternography and the success of TNB. CONCLUSIONS The present results suggest that the success of CBZ as initial treatment, but not NVC volume on MR cisternography, may be a significant predictor of the success of TNB as additional therapy in patients with TN.
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Prieto R, Pascual JM, Yus M, Jorquera M. Trigeminal neuralgia: Assessment of neurovascular decompression by 3D fast imaging employing steady-state acquisition and 3D time of flight multiple overlapping thin slab acquisition magnetic resonance imaging. Surg Neurol Int 2012; 3:50. [PMID: 22629487 PMCID: PMC3356991 DOI: 10.4103/2152-7806.96073] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 03/15/2012] [Indexed: 11/29/2022] Open
Abstract
Background: Trigeminal neuralgia is most commonly caused by vascular compression at the trigeminal nerve (TN) root entry zone. Microvascular decompression (MVD) has been established as a useful treatment. Outcome depends on the correct identification of the compression site and its adequate decompression at surgery. Preoperative identification of neurovascular compression might predict which patients will benefit from MVD. Management of persistent or recurrent trigeminal neuralgia after an MVD is a baffling problem for neurosurgeons. An accurate neuroradiological evaluation of the TN padding following a failed MVD might help identify the underlying cause and plan further treatment. Case description: A 68-year-old female presented with a right-sided trigeminal neuralgia (V3) refractory to medical therapy. A high-resolution three-dimensional magnetic resonance imaging (3D MRI) study included fast imaging employing steady-state acquisition (FIESTA) and time of flight multiple overlapping thin slab acquisition (TOF MOTSA) sequences to evaluate the neurovascular anatomy in the cerebellopontine angle. An unambiguous compression of the right TN at the rostral-medial site by the superior cerebellar artery (SCA) was identified. The SCA loop compressing the TN was identical in location and configuration to that predicted in the preoperative study. After the MVD, the patient was relieved from her pain and a postoperative high-resolution 3D MRI study confirmed the appropriate placement of the Teflon implant between the TN and SCA. Conclusion: To our knowledge, this is the first report that characterizes the proper TN padding by high-resolution 3D MRI after trigeminal MVD. The present case also emphasizes the importance of performing a 3D MRI in patients with trigeminal neuralgia to anticipate the surgeon's view and predict the outcome after MVD.
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Affiliation(s)
- Ruth Prieto
- Department of Neurosurgery, Clínico San Carlos University Hospital, Madrid, Spain
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Clerici AM, Merlo P, Rognone F, Noce M, Rognone E, Bono G. Persistent trigeminal artery causing "double" neurovascular conflict. Headache 2009; 49:472-6. [PMID: 19267790 DOI: 10.1111/j.1526-4610.2008.01258.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report the case of a 73-year-old woman who presented with right VI nerve palsy and homolateral atypical trigeminal neuralgia; standard neuroradiological investigation of orbital/retroorbital regions and intracranial arteries excluded the most commonly demonstrable underlying causes while brain magnetic resonance (T1-weighted fat suppression; T2-weighted thin-section) and magnetic resonance angiography disclosed the evidence of "double" neurovascular conflict because of persistent trigeminal artery with aneurysmal dilation. A role of this almost rare vascular condition in causing painful ophthalmoplegia is discussed.
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