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High-Resolution MRI Findings following Trigeminal Rhizotomy.
B G Northcutt1, D P Seeburg1, J Shin1
1From the Departments of Radiology and Radiologic Sciences, Division of Neuroradiology (B.G.N., D.P.S., J.S., N.A., A.M.B.).
AJNR. American Journal of Neuroradiology
|July 2, 2016
Summary
Radiologic changes after trigeminal rhizotomy for trigeminal neuralgia include nerve root clumping and decreased signal intensity in Meckel's cave. These findings, along with occasional temporal lobe encephalomalacia, are important for interpreting post-treatment MR imaging.
Area of Science:
- Radiology
- Neurology
- Neurosurgery
Background:
- Trigeminal neuralgia is commonly treated with radiofrequency thermocoagulation or glycerol injection.
- Radiologic changes following trigeminal rhizotomy have not been previously described.
- Understanding these changes is crucial for accurate interpretation of post-treatment imaging.
Purpose of the Study:
- To characterize radiologic changes in patients with trigeminal neuralgia after undergoing trigeminal rhizotomy.
- To evaluate these changes using 3D high-resolution MR imaging.
Main Methods:
- Retrospective review of 26 patients post-rhizotomy and 54 treatment-naïve patients.
- Independent review by two neuroradiologists blinded to treatment history.
- Assessment of Meckel's cave symmetry, contrast enhancement, and signal intensity on specific MRI sequences (CISS and VIBE).
Main Results:
- Nerve root clumping and decreased CISS signal intensity in Meckel's cave were observed in 65% of post-rhizotomy patients versus 6% of controls (P < .001).
- Mean CISS signal intensity was 13% lower on the rhizotomy side post-treatment compared to 1% in controls (P < .001).
- Temporal lobe encephalomalacia was noted in 31% of post-rhizotomy patients versus 0% of controls (P < .001).
Conclusions:
- Post-trigeminal rhizotomy findings commonly include nerve clumping and reduced CISS signal intensity in Meckel's cave.
- Temporal lobe encephalomalacia is a less frequent finding after trigeminal rhizotomy.
- These imaging findings aid in differentiating post-treatment changes from disease progression.
