Radiological evaluation of neurovascular Conflict in trigeminal neuralgia patients with High- Resolution MRI: Small case series

Arturs Balodis, Raimons Mikijanskis, Ramona Valante

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Abstract

Objectives. Trigeminal neuralgia is a condition characterized by neuropathic pain that occurs in the
sensory supply region of the trigeminal nerve. The common etiology of trigeminal neuralgia is vascular
compression on the trigeminal nerve root, commonly known as neurovascular conflict (NVC). Although
trigeminal neuralgia is a clinical diagnosis, radiological examination, preferably MRI, is used for further
evaluation of structural etiology and classification.
Patient A: a 77-year-old male, diagnosed with trigeminal neuralgia, presenting with severe electric-like
pain. Pharmacotherapy provided no relief. Primary MRI scan had no specific signs of NVC. Gasserian
ganglion block was performed after wich symptoms decreased for 6 months. Repeated blockade was
performed with no significant clinical effect. A second MRI scan, including additional high-resolution
sequences, showed a vessel near the proximal part of the left trigeminal nerve. A retrosigmoid craniotomy
and microvascular decompression was performed. NVC was confirmed during surgery.
Patient B: a 58-year-old female, diagnosed with trigeminal neuralgia, presenting with severe shock-like
pain. Carbamazepine treatment was effective, with effectiveness decreasing over time. On primary MRI there
were no signs of NVC. Second MRI scan with additional sequences did not prove or exclude the diagnosis
of NVC. Because of persistent symptoms a retrosigmoid craniotomy and microvascular decompression were
performed. NVC was confirmed during surgery.
Cases of 2 patients diagnosed with trigeminal neuralgia and severe facial pain for more than 5 years with
ineffective pharmacotherapy. Primary MRI scans without specific signs of NVC. Radiological evidence of
NVC was found on additional high-resolution MRI scans. During neurosurgery, NVC was confirmed. The
procedure was successful in both patients.
Conclusions. The most precise implements available for detection of NVC are high-resolution, T2W
MRI, 3D MRA sequences. Systemic approach of evaluation and application of recommended criteria is a
way to increase diagnostic accuracy of N VC
Original languageEnglish
Pages (from-to)292
Number of pages1
JournalMedicina (Kaunas)
Volume59
Issue numberSuppl.2
Publication statusPublished - 29 Mar 2023
EventRSU Research Week 2023: Research Week 2023 Rīga Stradiņš University - Riga Stradins University, Riga, Latvia
Duration: 27 Mar 202331 Mar 2023
https://rw2023.rsu.lv/general-information
https://rw2023.rsu.lv

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 3.4. Other publications in conference proceedings (including local)

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