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(a) Axial CISS image demonstrates the approximate location of the pontine trigeminal nuclei with their fibers projecting towards the anterolateral aspect of the pons to form the cisternal segment of CN V (black arrow), which extends anteriorly to enter the Meckel's cave through the porus trigeminus (white arrow). (b) Coronal CISS image shows the cisternal segment of CN bilaterally in cross section (black arrows). Coronal reconstructions are helpful for evaluation of neurovascular conflict.
Source publication
Trigeminal neuralgia is a debilitating pain syndrome in
the sensory distribution of the trigeminal nerve. Compression
of the cisternal segment of the trigeminal nerve by a vessel,
usually an artery, is considered the most common cause of
trigeminal neuralgia. A number of additional lesions may
affect the trigeminal nerve anywhere along its course f...
Contexts in source publication
Context 1
... mesencephalic nucleus mediates facial proprioception. In the pons, approximately at the level of the cisternal segment of CN V, the primary sensory nucleus mediates facial tactile sensation, and the motor nucleus innervates the muscles of the first branchial arch (Figure 1) (2). The spinal nucleus of CN V mediates facial pain and temperature, and is the largest nucleus extending from the dorsal aspect of the pons into the upper cervical cord. ...
Context 2
... spinal nucleus of CN V mediates facial pain and temperature, and is the largest nucleus extending from the dorsal aspect of the pons into the upper cervical cord. The cisternal segment of CN V arises from the anterolateral aspect of the pons ( Figure 1), and consists of a large sensory root comprising the main bulk of the nerve, and of one or more smaller motor roots arising superomedial to the sensory root (4). The cisternal segment of CN V crosses the cisternal space and enters the Meckel's cave through the porus trigeminus ( Figure 1). ...
Context 3
... cisternal segment of CN V arises from the anterolateral aspect of the pons ( Figure 1), and consists of a large sensory root comprising the main bulk of the nerve, and of one or more smaller motor roots arising superomedial to the sensory root (4). The cisternal segment of CN V crosses the cisternal space and enters the Meckel's cave through the porus trigeminus ( Figure 1). The trigeminal (or semilunar or gasserian) ganglion is centered along the anterior, inferior and lateral wall of the Meckel's cave, which is essentially a cerebrospinal fluid (CSF) filled space continuous with the subarachnoid space of the basal cisterns through the porus trigeminus (5). ...
Context 4
... trigeminal schwannomas occur in the Meckel's cave (18), and tend to grow in the parasellar region or extend through the porus trigeminus in the posterior fossa along the cisternal segment of the nerve (15). Vestibular schwannomas may enlarge enough to cause TN (1, 12). Other common benign lesions in the skull base that may present with TN or trigeminal dysfunction include meningioma ( Figure 4B) and epidermoid ( Figure 4C). ...
Citations
... The trigeminal nerve (fifth cranial nerve) is a mixed sensorimotor nerve, with three sensory nuclei and one motor nuclei [1,2], It is most commonly susceptible to neuropathic pain, also known as trigeminal neuralgia (TN), that arises out of conflict in the sensory region of the nerve. The prevalence of TN has been reported to be up to 4-13 cases per 100,000 population, with a primary predilection for females and the age groups of the 40s, 50s, and 60s [2,3]. ...
... TN is a debilitating disorder due to severe, episodic, unilateral stabbing facial pain which may be triggered by a simple touch, cleaning teeth, washing, and shaving, disturbing enough to disrupt the daily activities of living of a person, leading to depression in some cases [1,4]. ...
... We cannot proceed with surgery without obtaining an MRI. Moreover, MRI also allows for the detection of secondary pathologies that may be present, such as tumors, demyelination, mass lesions, and infections, around the nerve which may lead to classic TN [1,[5][6][7]. ...
Trigeminal neuralgia (TN) is a debilitating disorder causing severe, episodic, unilateral stabbing facial pain disturbing enough to disrupt the activities of daily life. Classic TN is caused due to compression injury of the trigeminal nerve at the cistern segment caused by either an artery or a vein, referred to as neurovascular contact or conflict (NVC). Magnetic resonance imaging (MRI) has been the standard tool for the diagnosis of NVC. This study aimed to determine the incidence of NVC in TN, as identified by MRI, assess the various MRI grading patterns among patients with TN, and identify the vessels primarily involved in NVC. A systematic search of studies that used MRI for the diagnosis of TN in reference to NVC was conducted on DOAJ and PubMed/PubMed Central. Data were extracted and entered into a Microsoft Excel spreadsheet. The outcomes measured were the incidence of NVC as shown in MRI, vessels involved in NVC, and MRI grading patterns. We identified and selected 20 studies that fulfilled inclusion/exclusion criteria. In total, 1,436 patients were enrolled in all included studies. The type of MRI used was 1.5 T or 3 T MRI. The mean age of the patients varied from 49 to 63 years, with an equivalent male-to-female ratio. NVC was seen in 1,276 cases out of 1,436 cases (88.85%) of TN on the ipsilateral side, as shown by MRI. The vessels involved were arteries in 80-90% of the cases, followed by veins. Among the arteries, the superior cerebellar artery was the most common artery (80-90% of cases). The grades of NVC as assessed by MRI included grades I, II, and III with varied proportions in different studies. NVC is a common problem in TN, wherein there is compression at the nerve root entry zone, and it shows a strong predilection for the elderly population. MRI seems to be a novel imaging diagnostic investigation to identify NVC associated with TN. Moreover, NVC grading must be done with MRI so that it may help the surgeon in stratifying the patient’s treatment.
... Kemik artifaktı yoktur ve iyonize radyasyon kullanmadan koronal planda direkt olarak incelemeye imkân veren multiplanar kapasiteye sahiptir. (Kontzialis & Kocak, 2017;Şevket Murat Özbek, 2016). ...
... Kemik artifaktı yoktur ve iyonize radyasyon kullanmadan koronal planda direkt olarak incelemeye imkân veren multiplanar kapasiteye sahiptir. (Kontzialis & Kocak, 2017;Şevket Murat Özbek, 2016). ...
... CTN is characterized by unilateral facial pain with an abrupt onset and ofset, which localizes to one or more branches of the trigeminal nerve [1]. It is generally considered that the most common cause of trigeminal neuralgia is the compression of trigeminal nerve by vessels, especially the arteries [2,3]. Sufering from severe facial pain, CTN patients not only present signifcant social disability [4] but also present cognitive decline, memory loss, anxiety, depressive tendencies, and negative pain-related changes [5]. ...
Purpose:
Diffusion tensor imaging (DTI) and resting-state functional magnetic resonance imaging (rs-fMRI) were applied to speculate the altered structural and functional abnormalities within the hippocampus in classical trigeminal neuralgia (CTN) patients by detecting the alteration of apparent diffusion coefficient (ADC), fractional anisotropy (FA), and regional homogeneity (ReHo). Patients and Methods. Multimodal MRI dataset (DTI and fMRI) and clinical indices (pain and neuropsychological scores) were collected in 27 CTN patients and 27 age- and gender-matched healthy controls (HC). Two independent-sample t-tests were performed to compare the ADC, FA, and ReHo values in hippocampus areas between CTN patients and HC. Correlation analyses were applied between all the DTI and fMRI parameters within the hippocampus and the VAS (visual analog scale), MoCA (Montreal cognitive assessment), and CDR (clinical dementia rating) scores.
Results:
CTN patients showed a significantly increased FA values in the right hippocampus (t = 2.387, P = 0.021) and increased ReHo values in the right hippocampus head (voxel P < 0.001, cluster P < 0.05, FDR correction) compared with HC. A positively significant correlation was observed between the ReHo values and MOCA scores in the right hippocampus head; FA values were also positively correlated with MOCA scores in the right hippocampus.
Conclusion:
CTN patients demonstrated an abnormality of structures and functions in the hippocampus, which may help to provide novel insights into the neuropathologic change related to the pain-related dysfunction of CTN.
... Trigeminal neuralgia (TN), also known as tic douloureux, is an electric shock-like or stabbing chronic neuropathic pain disorder that occurs in a region of the face [1]. The ophthalmic (V1), maxillary (V2), and mandibular (V3) branches of the trigeminal nerve arise from the skull base, and pain most commonly affects the distribution of the V2 and V3 segments [1,2]. Depending on the severity of the pain, the quality of life of patients with TN decreases, and even daily activities such as talking, washing face, and chewing are sometimes restricted [1,3]. ...
... We attributed this to the anatomical features of the nerve and cistern. The cisternal segment of the trigeminal nerve, as is well known, arises from the anterolateral aspect of the pons, then courses through the prepontine cistern into the Meckel's cave [2,33]. ...
Background:
Morphological differences that can lead the trigeminal nerve to neurovascular conflict and a new solitary pontine lesion are associated with the pathogenesis of trigeminal neuralgia (TN). In this case-control study, we aimed to contribute to the current discussions about the pathogenesis of TN by investigating the anatomical structures that may have an effect on the morphometric parameters of the trigeminal nerve.
Methods:
This study included 25 patients with TN followed up for pain in the Department of Algology, Faculty of Medicine, and 25 age- and gender-matched controls. We performed morphometric measurements including the length and volume of the trigeminal nerve, cerebellopontine cistern, pons, and posterior fossa in the MRIs of these individuals. Comparative analyses were performed for the mean of the affected and unaffected sides of the TN patients and the right, left, and both sides of the control group.
Results:
In patients with TN, on the affected side, length and volume of the trigeminal nerve and cerebellopontine cistern volume were found smaller than controls (p < 0.05). Pons volume was higher in patients with TN compared to controls (p < 0.05). The length of the affected nerve was significantly related to prepontine cistern length and cerebellopontine cistern volume (p < 0.05).
Discussion:
The cerebellopontine cistern volume has a significant impact on the morphometric characteristics of the trigeminal nerve. Especially, whether the increase in the volume of pons causes a decrease in the volume of cerebellopontine cistern should be clarified with further research.
... The initial presentation of TNp can include pain; however, with disease progression, facial numbness and masticatory muscle weakness may predominate [8]. As TNp may be the initial presentation, malignancies of the head and neck should always be in the differential diagnosis, and a high-resolution magnetic resonance imaging (MRI) of the brain and skull base with and without gadolinium enhancement is paramount [9]. ...
Trigeminal neuropathies (TNp) are a group of well-characterized disorders that involve damage to or infiltration of the trigeminal nerve. The underlying etiology of trigeminal neuropathy can be traumatic, inflammatory, autoimmune, paraneoplastic, malignant, and very rarely infectious. We present a case of trigeminal neuropathy due to local malignant invasion of the mandibular nerve with mandibular nerve enhancement at the foramen ovale and foramen rotundum. In the process, we review various etiologies of trigeminal neuropathy associated with trigeminal nerve involvement at the foramina. We emphasize the importance of a comprehensive evaluation in patients with trigeminal neuropathy, which includes searching for perineural spread or invasion by a local head and neck malignancy, as well as ruling out an inflammatory or autoimmune etiology. Our case also demonstrates that a higher field strength magnet can reveal pathology unseen with a lower field strength magnet.
... Classic TN is most often (80-90%) secondary to the neurovascular conflict (NVC), which indicates symptomatic affection of the cisternal segment of the trigeminal nerve by the vascular structure [11]. The NVC can range from simple contact to severe compression, displacement, or loss of nerve volume [28]. The involved vessels are most often arterial, particularly the superior cerebellar artery (75-88%) and the anterior inferior cerebellar artery (9.6-25%) [13,33]. ...
Objective
Trigeminal neuralgia (TN) is a lightning bolt of violent, electrifying, and stinging pain, often secondary to the neurovascular conflict (NVC). The vessels involved in NVC are mostly arteries and rarely veins. Evaluation of NVC in the deep infratentorial region is inseparably connected with cranial imaging. We retrospectively analyzed the potential influence of three-dimensional (3D) virtual reality (VR) reconstructions compared to conventional magnetic resonance imaging (MRI) scans on the evaluation of NVC for the surgical planning of microvascular decompression in patients with TN.
Methods
Medical files were retrospectively analyzed regarding patient- and disease-related data. Preoperative MRI scans were retrospectively visualized via VR software to detect the characteristics of NVC. A questionnaire of experienced neurosurgeons evaluated the influence of VR visualization technique on identification of anatomical structures involved in NVC and on surgical strategy.
Results
Twenty-four patients were included and 480 answer sheets were evaluated. Compared to conventional MRI, image presentation using 3D-VR modality significantly influenced the identification of the affected trigeminal nerve (p = 0.004), the vascular structure involved in the NVC (p = 0.0002), and the affected side of the trigeminal nerve (p = 0.005).
Conclusions
In patients with TN caused by NVC, the reconstruction of conventional preoperative MRI scans and the spatial and anatomical presentation in 3D-VR models offers the possibility of increased understanding of the anatomy and even more the underlying pathology, and thus influences operation planning and strategy.
... In such cases, it is pivotal to exclude any abnormality at the skull base or within the proximity of the trigeminal ganglion. This may be overlooked especially when the numbness spreads gradually or the trigeminal motor function and corneal reflexes remain intact [10]. Furthermore, it is important that all cases of trigeminal neuropathy workup include an assessment of the skull base with a high-resolution MRI study with and without contrast enhancement. ...
We describe a case of Sjögren's syndrome-associated trigeminal neuropathy with mandibular nerve enhancement at the foramen ovale and Gasserian ganglion (Meckel's cave) in a patient with a prior history of breast cancer. We also explore the differential diagnosis of trigeminal neuropathy associated with mandibular nerve involvement at the foramen ovale and exclude other diseases such as Sjögren's syndrome or perineurial invasion as a result of various carcinomas. We emphasize the importance of an investigative triad of searching for a local head-and-neck malignancy that may metastasize by perineural spread or invasion, excluding a distant malignancy or paraneoplastic phenomenon and ruling out an autoimmune etiology such as Sjögren's syndrome. In the process, we briefly outline the basic immunopathologic processes.
... Notably, BoNT/A has been given official approval for preventive therapy of chronic migraine by Food and Drug Administration (FDA) in pain medicine (33). BoNTs can alleviate trigeminal neuralgia and can last for 6 months or more (34). Recently, BoNTs is also applied for the management of motor and non-motor symptoms in Parkinson's disease (PD) patients (35). ...
Depression is one of the most common mental disorders, which causes global burden. Antidepressants and psychotherapies are the mainstay of treatment for depression, which have limited efficacy. Thus, alternative approaches for preventing and treating depression are urgently required. Recent clinical trials and preclinical researches have clarified that peripheral facial injection of botulinum neurotoxin type A (BoNT/A) is a rapid, effective and relative safe therapy for improving some symptoms of depression. Despite its safety and efficacy, the underlying therapeutic mechanisms of BoNT/A for depression remains largely unclear. In the present review, we updated and summarized the clinical and preclinical evidence supporting BoNT/A therapy for the treatment of depression. We further discussed the potential mechanisms underlying therapeutic effects of BoNT/A on depression. Notably, we recently identified that the anti-depressant effects of BoNT/A associated with up-regulation of 5-HT levels and brain-derived neurotrophic factor (BDNF) expression in the hippocampus in a preclinical mouse model. In summary, these studies suggest that BoNT/A therapy is a potential effective and safe intervention for the management of depression. However, fundamental questions remain regarding the future prospects of BoNT/A therapy, including safety, efficacy, dose-response relationships, identification of potential predictors of response, and the precise mechanisms underlying BoNT/A therapy.
... It has been reported that tumors in the cavernous sinus area [4], tuberculomas [5], vascular lesions [6] and paranasal sinus infections [6] in diabetic patients cause trigeminal neuralgia. In only one case, the association of THS and persistent pain in the first and second branches of the trigeminal nerve without a neuralgiform character was reported [7]. ...
... It has been reported that tumors in the cavernous sinus area [4], tuberculomas [5], vascular lesions [6] and paranasal sinus infections [6] in diabetic patients cause trigeminal neuralgia. In only one case, the association of THS and persistent pain in the first and second branches of the trigeminal nerve without a neuralgiform character was reported [7]. ...
