New Clinical and Morphologic Aspects in Trigeminal Neuralgia

Area of Science:

• Neurology
• Radiology
• Neuroscience

Background:

• Trigeminal neuralgia (TN) is a debilitating condition often caused by neurovascular compression (NVC).
• High-resolution magnetic resonance imaging (MRI) is crucial for visualizing the intricate details of NVC.

Purpose of the Study:

• To correlate specific morphologic parameters of NVC with the clinical presentation of trigeminal neuralgia (TN).
• To evaluate the diagnostic significance of MRI findings in patients with TN.

Main Methods:

• 180 patients with TN underwent high-resolution MRI (constructive interference in steady state/time of flight).
• Analysis included NVC site, nerve deformity, vascular loops, cerebrospinal fluid (CSF) sign, and causative vessel localization.
• Correlation of imaging findings with affected trigeminal nerve branches (V1, V2, V3).

Main Results:

• The cerebrospinal fluid (CSF) sign was exclusively observed in V1 affection (100% specificity).
• Nerve deformity was present in 35% of patients, strongly correlating with the side of TN.
• Cranial vascular loops were the most frequent compression type, followed by mediocranial loops.

Conclusions:

• The CSF sign is pathognomonic for V1 trigeminal neuralgia (TN) affection.
• MRI-based classification of NVC findings is reproducible and valuable for preoperative evaluation.
• Understanding NVC morphology aids in diagnosing and managing TN.