MRI Findings in Trigeminal Neuralgia Without Apparent Vascular Abnormality

Document Type : Original Article

Authors

1 Department of Radiology, Dameitta Faculty of Medicine, Al-Azhar University, Egypt

2 Department of Radiodiagnosis, Faculty of medicine, Al-Azhar University, Cairo, Egypt.

3 Department of Radiodiagnosis, Damietta Faculty of medicine, Al-Azhar University, Damietta, Egypt.

Abstract

Background: Trigeminal neuralgia [TN] is a challenging health problem. It is usually ascribed to vascular abnormalities. However, a significant proportion does not show apparent abnormality in the vascular system. Thus, its diagnosis is a challenge. It is suggested that magnetic resonance imaging [MRI] could play a role in diagnosis of such cases.
Aim of the Work: This study was designed to evaluate the MRI finding in different causes of trigeminal neuralgia without apparent vascular abnormality.
Patients and Methods: This is a prospective study, including 40 cases presented clinically with TN. All were submitted to full clinical evaluation [history taking, clinical examination and laboratory investigations]. Then, MRI was performed for all patients and different measures were recorded and the diagnosis was determined.
Results: Most lesions were unilateral [47.5% on the left and 40.0% on the right].  Tumors were the most common [30.0%] followed by the vascular and idiopathic categories [each 22.5%]. The types of TN were vascular compression [22.5%], secondary types [55.0%] and idiopathic [22.5%].  The mean pontine angle was significantly lower in the affected than the non-affected side [29.3 ± 6.7° vs 37.01±7.6°]. The diagnostic performance of trigeminal pontine angle, length of cisternal segment and cross section area of CPA showed that the AUC are 0.8 and above. The best was registered for trigeminal pontine angle [0.83] followed by length of internal segment [0.81]. The sensitivity was 88.9%, 88.9% and 77.8% for trigeminal pontine angle, length of cisternal segment and cross section area of CPA, respectively.
Conclusion: MRI is an excellent imaging modality for diagnosing the etiology TN. FIESTA MRI act as adjuvant to increase diagnostic accuracy and determine specific etiology of TN through measurement of trigeminal pontine angle, length of cisternal segment of nerve and cross-sectional area of CPA, especially in idiopathic cases.

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