A study to evaluate neurovascular conflict of trigeminal nerve in trigeminal neuralgia patients with the help of 1.5 T MR imaging

Abstract

Introduction: Trigeminal neuralgia is a neuropathic pain that occurs in the sensory supply region of the trigeminal nerve (V cranial nerve). The common etiology of trigeminal neuralgia is said to be vascular compression on the trigeminal nerve root. In our day-to-day practice, we see many asymptomatic patients having vascular loops around the trigeminal nerve root. We undertook this study to see the significance of nerve root compression by the vascular loop as a cause for trigeminal neuralgia. Materials and methods: A total of 67 classical trigeminal neuralgia patients with NVC involving the trigeminal nerve as diagnosed on MRI brain sequences including FIESTA sequence were included in the study. NVC in all the patients were studied for the side, site of neurovascular contact of cisternal segment of the trigeminal nerve from the brainstem, deviation of nerve at NVC, atrophy of nerve, nature and origin of vascular loop causing NVC and correlated with TGN symptoms. Results: Out of 67 patients studied, all of them (100%) had NVC on ipsilateral side and 26 patients (34%) had NVC at contralateral trigeminal nerve. Incidence of trigeminal neuralgia was most commonly seen between the 41 and 60 years age (64%) followed by 61–80 years with mean age of 55.6 years. Incidence in females (64%) was found to be more common than in males (35%). NVC was observed at the root entry zone (< 7 mm from brain stem) in 63 trigeminal nerves on symptomatic side and 5 trigeminal nerves on the asymptomatic side. NVC occurring at REZ on symptomatic side was found to be statistically significant with P < 0.001. Mean distance of NVC from brain stem at symptomatic side was 3.4 mm and was 8.4 mm in asymptomatic side NVCs. Atrophy was seen in 8 trigeminal nerves, all on symptomatic side and NVC occurring at root entry zone. No displacement of nerve root at the point of neurovascular contact was observed in our study. Most common vessel causing was found to be ipsilateral superior cerebellar artery followed by the ipsilateral anterior inferior cerebellar artery. Conclusions: Neurovascular contact of trigeminal nerve occurring at the nerve root entry zone has a strong association with ipsilateral trigeminal neuralgia symptoms. In addition, the presence of the trigeminal nerve thinning is also associated with ipsilateral trigeminal neuralgia. With the increase in age, there are higher chances of association of NVC with ipsilateral trigeminal neuralgia symptoms.