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Segmental Imaging of the Trochlear Nerve: Anatomic and Pathologic Considerations.

Nivedita Agarwal¹, Ali Karim Ahmed, Richard H Wiggins

¹Section of Radiology (Nivedita Agarwal), Hospital Santa Maria del Carmine, Rovereto, Italy ; Division of Neuroradiology (Nivedita Agarwal, RHW), Department of Radiology. University of Utah, Salt Lake City, Utah; Department of Neurosurgery (AKA, GLG), the Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Neuro-ophthalmology (TJM), Department of Ophthalmology, the Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Neuroradiology (MK), Department of Diagnostic Radiology, Rush University Medical Center, Chicago, Illinois; Department of Neuroradiology (LLM), Cedimagem/Alliar Diagnostic Center, Juiz de Fora, Brazil; Department of Radiology (AFC), Le Bonheur Children's Hospital, the University of Tennessee Health Sciences Center, Memphis, Tennessee; Department of Opththalmology (LCD), St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Otolaryngology Head and Neck Surgery (MI), the Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Neuroradiology (Nafi Aygun), Department of Radiology, the Johns Hopkins School of Medicine, Baltimore, Maryland; and Division of Neuroradiology (AMB), Department of Radiology, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society

|November 2, 2020

Summary

High-resolution 3D MRI aids in visualizing the trochlear nerve (fourth cranial nerve), crucial for diagnosing trochlear nerve palsy. A segmental approach improves identification and assessment of this smallest cranial nerve.

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Area of Science:

Neuroimaging
Anatomy
Radiology

Background:

The trochlear nerve (fourth cranial nerve) originates from the midbrain's dorsal aspect.
Its extensive pathway makes it vulnerable to injury.
It is the smallest cranial nerve and challenging to visualize on standard neuroimaging.

Purpose of the Study:

To review the detailed anatomy of the fourth cranial nerve relevant for imaging.
To emphasize the importance of detailed anatomical knowledge for diagnosing trochlear nerve palsy.

Main Methods:

Utilizing high-resolution, 3-dimensional (3D) skull base MRI with submillimeter isotropic acquisition.
Employing a systematic, segmental approach for evaluating each segment of the trochlear nerve.

Main Results:

High-resolution 3D MRI is optimal for cranial nerve evaluation.
Detailed anatomical knowledge of each trochlear nerve segment is essential for clinical practice.
Pathologic examples are presented for each nerve segment.

Conclusions:

A segmental approach using high-resolution 3D MRI is recommended for studying the trochlear nerve.
This method facilitates accurate identification and assessment of the trochlear nerve and its associated pathologies.