Department of Neurosurgery, School of Medicine, Pontificia Universidad Católica de Chile, Chile.
Eur J Radiol. 2012 Aug;81(8):1851-7. doi: 10.1016/j.ejrad.2009.09.017. Epub 2009 Oct 12.
To describe the anatomical characteristics and patterns of neurovascular compression in patients suffering classic trigeminal neuralgia (CTN), using high-resolution magnetic resonance imaging (MRI).
The analysis of the anatomy of the trigeminal nerve, brain stem and the vascular structures related to this nerve was made in 100 consecutive patients treated with a Gamma Knife radiosurgery for CTN between December 1999 and September 2004. MRI studies (T1, T1 enhanced and T2-SPIR) with axial, coronal and sagital simultaneous visualization were dynamically assessed using the software GammaPlan™. Three-dimensional reconstructions were also developed in some representative cases.
In 93 patients (93%), there were one or several vascular structures in contact, either, with the trigeminal nerve, or close to its origin in the pons. The superior cerebellar artery was involved in 71 cases (76%). Other vessels identified were the antero-inferior cerebellar artery, the basilar artery, the vertebral artery, and some venous structures. Vascular compression was found anywhere along the trigeminal nerve. The mean distance between the nerve compression and the origin of the nerve in the brainstem was 3.76±2.9mm (range 0-9.8mm). In 39 patients (42%), the vascular compression was located proximally and in 42 (45%) the compression was located distally. Nerve dislocation or distortion by the vessel was observed in 30 cases (32%).
The findings of this study are similar to those reported in surgical and autopsy series. This non-invasive MRI-based approach could be useful for diagnostic and therapeutic decisions in CTN, and it could help to understand its pathogenesis.
使用高分辨率磁共振成像（MRI）描述患有典型三叉神经痛（CTN）患者的神经血管压迫的解剖学特征和模式。
对 1999 年 12 月至 2004 年 9 月期间接受伽玛刀放射外科治疗的 100 例连续 CTN 患者的三叉神经、脑干和与该神经相关的血管结构进行解剖分析。使用 GammaPlan™软件对同时进行轴位、冠状位和矢状位动态评估的 MRI 研究（T1、T1 增强和 T2-SPIR）进行分析。在一些代表性病例中还进行了三维重建。
在 93 例患者（93%）中，有一个或多个血管结构与三叉神经接触，或者靠近其在脑桥中的起源。小脑上动脉受累 71 例（76%）。其他确定的血管包括前下小脑动脉、基底动脉、椎动脉和一些静脉结构。血管压迫发生在三叉神经的任何部位。神经压迫与脑干中神经起源之间的平均距离为 3.76±2.9mm（范围 0-9.8mm）。在 39 例患者（42%）中，血管压迫位于近端，在 42 例患者（45%）中，压迫位于远端。在 30 例患者（32%）中观察到血管引起的神经脱位或扭曲。
本研究的结果与手术和尸检系列报道的结果相似。这种基于 MRI 的非侵入性方法可用于 CTN 的诊断和治疗决策，并有助于理解其发病机制。
