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Radiology for Trigeminal Neuralgia

  • Pankaj Surange
  • Harshita Surange
  • Gaurav Goyal
Chapter

Abstract

The diagnosis of trigeminal neuralgia (TGN) is mainly based on patient’s history and clinical examination. Classically, the patient presents with characteristic paroxysm of pain, with short and severe episodes, which is typically unilateral, and along the course of the trigeminal nerve. There is a greater predilection towards the right side. Apart from the idiopathic variety, secondary causes of TGN must be ruled out, as neuropathy of trigeminal nerve may involve the nerve anywhere along its course, from the nerve nuclei to the peripheral branches. Since clinical findings alone are not sufficient to localize the site of the causative lesion, magnetic resonance imaging (MRI) must be carried out before any intervention is planned. Imaging may also help to diagnose an enlarged loop of artery or vein compressing the trigeminal nerve, i.e. neurovascular compression (NVC) at the cerebellopontine (CP) angle, plaques in multiple sclerosis (MS), and tumor in the CP angle region. A thorough understanding of the x-ray anatomy of base and lateral view of the skull is important, as majority of the interventions are performed with fluoroscopic-guided techniques. This chapter covers the diagnostic and therapeutic aspects of radiology in patients of TGN.

References

  1. 1.
    Nicolás S, Andrés S, Osmar T, Inés D, Jorge B, Víctor S. Anatomy of the trigeminal nerve. Key anatomical facts for mri examination of trigeminal neuralgia. Rev Imagenol. 2009;12:28–33.Google Scholar
  2. 2.
    Kontzialis M, Kocak M. Imaging evaluation of trigeminal neuralgia. J Istanb Univ Fac Dent. 2017;51(3 Suppl 1):S62–8.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Donia MM, Gamaledin OA, Abdo AM, Desouky SE, Helmy SA. Intracranial neoplastic lesions of the trigeminal nerve: How MRI can help. Egypt J Radiol Nucl Med. 2017;48:1035–41.CrossRefGoogle Scholar
  4. 4.
    Majoie CB, Verbeeten B, Dol A, Peeters LM. Trigeminal neuropathy: evaluation with MR imaging. Radiographics. 1995;15:795–811.CrossRefGoogle Scholar
  5. 5.
    Tash RR, Sze G, Leslie DR. Trigeminal neuralgia: MR imaging features. Radiology. 1989;172:767–70.CrossRefGoogle Scholar
  6. 6.
    Besta R, Shankar YU, Kumar A, Rajasekhar E, Prakash SB. MRI 3D CISS- a novel imaging modality in diagnosing trigeminal neuralgia—a review. J Clin Diagn Res. 2016;10:ZE01–3.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Yousry I, Moriggl B, Schmid UD, et al. Trigeminal ganglion and its divisions: detailed anatomic MR imaging with contrast-enhanced 3D constructive interference in the steady state sequences. AJNR Am J Neuroradiol. 2005;26:1128–35.PubMedGoogle Scholar
  8. 8.
    Harsha KJ, Kesavadas C, Chinchure S, Thomas B, Jagtap S. Imaging of vascular causes of trigeminal neuralgia. J Neuroradiol. 2012;39:281–9.CrossRefGoogle Scholar
  9. 9.
    Fujiwara S, Sasaki M, Wada T, Kudo K, Hirooka R, Ishigaki D, et al. High-resolution diffusion tensor imaging for the detection of diffusion abnormalities in the trigeminal nerves of patients with trigeminal neuralgia caused by neurovascular compression. J Neuroimaging. 2011;21:e102–8.CrossRefGoogle Scholar
  10. 10.
    Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg. 1967;26:159–62.CrossRefGoogle Scholar
  11. 11.
    Peker S, Kurtkaya O, Uzün I, Pamir MN. Microanatomy of the central myelin-peripheral myelin transition zone of the trigeminal nerve. Neurosurgery. 2006;59:354–9.CrossRefGoogle Scholar
  12. 12.
    Haller S, Etienne L, Kovari E, Varoquaux AD, Urbach H, Becker M. Imaging of neurovascular compression syndrome: trigeminal neuralgia, hemifacial spasm, vestibular paroxysmia, and glossopharyngeal neuralgia. AJNR. 2016;37:1384–92.CrossRefGoogle Scholar
  13. 13.
    Hughes MA, Frederickson AM, Branstetter BF, Zho X, Sekula RF. MRI of trigeminal nerve in patients with trigeminal neuralgia secondary to vascular compression. AJR. 2016;206:595–600.CrossRefGoogle Scholar
  14. 14.
    Son BC, Kim HS, Kim IS, Yang SH, Lee SW. Percutaneous radiofrequency thermocoagulation under fluoroscopic image-guidance for idiopathic trigeminal neuralgia. J Korean Neurosurg Soc. 2011;50:446–52.CrossRefGoogle Scholar
  15. 15.
    Hertel F. Uber die intracranielle injektionsbehandlung der trigeminusneuralgie. Med Klin. 1914;10:582.Google Scholar
  16. 16.
    Lai GH, Tang YZ, Wang XP, Qin HJ, Ni JX. CT-guided percutaneous radiofrequency thermocoagulation for recurrent trigeminal neuralgia after microvascular decompression: a cohort study. Medicine (Baltimore). 2015;94:e1176.CrossRefGoogle Scholar
  17. 17.
    Tang YZ, Jin D, Bian JJ, Li XY, Lai GH, Ni JX. Long-term outcome of computed tomography guided percutaneous radiofrequency thermocoagulation for classic trigeminal neuralgia patients older than 70 years. J Craniofac Surg. 2014;25:1292–5.CrossRefGoogle Scholar
  18. 18.
    Fang L, Ying S, Tao W, Lan M, Xiaotong Y, Nan J. 3D CT-guided pulsed radiofrequency treatment for trigeminal neuralgia. Pain Pract. 2014;14:16–21.CrossRefGoogle Scholar
  19. 19.
    Patil AA, Chamczuk AJ, Nelson B. Stereotactic radiofrequency ablation of trigeminal ganglion with intraoperative CT scans and under general anesthesia. Open J Mod Neurosurg. 2016;6:55–9.CrossRefGoogle Scholar
  20. 20.
    Seeburg DP, Northcutt B, Aygun N, Blitz AM. The role of imaging for trigeminal neuralgia: a segmental approach to high-resolution MRI. Neurosurg Clin N Am. 2016;27:315–26.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Pankaj Surange
    • 1
    • 2
  • Harshita Surange
    • 3
  • Gaurav Goyal
    • 2
  1. 1.World Institute of Pain (India Chapter)New DelhiIndia
  2. 2.Interventional Pain and Spine Centre (IPSC)New DelhiIndia
  3. 3.Diagnostic and Imaging CentreNew DelhiIndia

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