Skip to main content

Advertisement

SpringerLink
Log in

The role of the cerebellopontine angle cistern area and trigeminal nerve length in the pathogenesis of trigeminal neuralgia: a prospective case-control study

  • Clinical Article - Neurosurgical Anatomy
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

The aim of this prospective study was to evaluate whether the cerebellopontine angle (CPA) cistern area and trigeminal nerve cisternal length play a role in the pathogenesis of trigeminal neuralgia (TN).

Methods

High-resolution 1.5 T magnetic resonance imaging of the posterior fossa was performed in 26 patients with TN and 18 age-matched healthy controls. Axial T2-weighted, three-dimensional constructive interference in steady-state (3D-CISS) was used to measure bilaterally the cross-sectional area of the CPA cistern and trigeminal nerve cisternal length.

Results

In patients, the cross-sectional area of the CPA cistern and trigeminal nerve cisternal length was smaller on the affected side (p = 0.04). Healthy controls tended to have larger cisternal areas and longer trigeminal nerve lengths than patients (p = 0.059, p = 0.071, respectively). Larger CPA cisternal areas tended to be seen in older patients. There was a strong correlation between the cross-sectional area of the CPA cistern and the length of the trigeminal nerve (p = 0.000).

Conclusions

Smaller CPA cisterns and short cisternal trigeminal nerves impact the pathogenesis of essential TN by facilitating the neurovascular conflict, especially in younger patients. Trigeminal nerve cisternal measurement provides an easy and direct estimation of the CPA area. This information can be used for surgical planning and potentially for outcome prediction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Borges A, Casselman J (2010) Imaging the trigeminal nerve. Eur J Radiol 74:323–340

    Article  PubMed  Google Scholar 

  2. Devor M, Amir R, Rappaport ZH (2002) Pathophysiology of trigeminal neuralgia: the ignition hypothesis. Clin J Pain 18:4–13

    Article  PubMed  Google Scholar 

  3. Gardner WJ, Dohn DF (1966) Trigeminal neuralgia, hemifacial spasm, Paget’s disease: significance of this association. Brain 89:555–562

    Article  PubMed  CAS  Google Scholar 

  4. Gnanalingham K, Joshi SM, Lopez B, Ellamushi H, Hamlyn P (2005) Trigeminal neuralgia secondary to Chiari’s malformation—treatment with ventriculoperitoneal shunt. Surg Neurol 63:586–588

    Article  PubMed  Google Scholar 

  5. Ha SM, Kim SH, Yoo EH, Han I, Shin DA, Cho KG, Chung SS, Park YS (2012) Patients with idiopathic trigeminal neuralgia have a sharper-than-normal trigeminal-pontine angle and trigeminal nerve atrophy. Acta Neurochir (Wien). doi:10.1007/s00701-012-1327-z

  6. Headache Classification Committee of the International Headache Society (2004) The International Classification of Headache Disorders, 2nd edition. Cephalalgia 24:126–135

    Google Scholar 

  7. Horinek D, Brezova V, Nimsky C, Belsan T, Martinkovic L, Masopust V, Vrána J, Kozler P, Plas J, Krysl D, Varjassyová A, Ghaly Y, Benes V (2009) The MRI volumetry of the posterior fossa and its substructures in trigeminal neuralgia: a validated study. Acta Neurochir (Wien) 151:669–675

    Article  CAS  Google Scholar 

  8. Leal PR, Froment JC, Sindou M (2010) MRI sequences for detection of neurovascular conflicts in patients with trigeminal neuralgia and predictive value for characterization of the conflict (particularly degree of vascular compression). Neurochirurgie 56:43–49

    Article  PubMed  CAS  Google Scholar 

  9. Mueller HR, Levy A (1963) On the pathogenesis of trigeminal neuralgia. Study of mechanical factors by means of craniometry. Acta Neurochir (Wien) 11:385–397

    Article  CAS  Google Scholar 

  10. Parise M, Ribeiro CT, Vincent M, Gasparetto EL (2010) Small cerebellopontine angle cisterns inpatients with trigeminal neuralgia. J Neurosurg 112:900–901

    Article  PubMed  Google Scholar 

  11. Park SH, Hwang SK, Lee SH, Park J, Hwang JH, Hamm IS (2009) Nerve atrophy and a small cerebellopontine angle cistern in patients with trigeminal neuralgia. J Neurosurg 110:633–637

    Article  PubMed  Google Scholar 

  12. Rasche D, Kress B, Stippich C, Nennig E, Sartor K, Tronnier V (2006) Volumetric measurement of the pontomesencephalic cistern in patients with trigeminal neuralgia and healthy controls. Neurosurgery 59:614–620

    Article  PubMed  Google Scholar 

  13. Sindou M, Leston JM, Decullier E, Chapuis F (2008) Microvascular decompression for trigeminal neuralgia: the importance of a noncompressive technique—Kaplan-Meier analysis in a consecutive series of 330 patients. Neurosurgery 63:341–350

    Article  PubMed  Google Scholar 

  14. Sindou M, Leston J, Howeidy T, Decullier E, Chapuis F (2006) Micro-vascular decompression for primary Trigeminal Neuralgia (typical or atypical). Long-term effectiveness on pain; prospective study with survival analysis in a consecutive series of 362 patients. Acta Neurochir (Wien) 148:1235–1245

    Article  CAS  Google Scholar 

  15. Takada Y, Morimoto T, Sugawara T, Ohno K (2001) Trigeminal neuralgia associated with achondroplasia. Case report with literature review. Acta Neurochir (Wien) 143:1173–1176

    Article  CAS  Google Scholar 

Download references

Conflicts of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Maud Parise, Maurice Vincent & Emerson Leandro Gasparetto

  2. Department of Surgical Specialties, Division of Neurosurgery, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard Vinte e Oito de Setembro, 77 – Vila Isabel, Rio de Janeiro, RJ, Brazil, 20551-900

    Maud Parise, Marcus André Acioly & Carlos Telles Ribeiro

  3. Department of Neurology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Maurice Vincent

Authors
  1. Maud Parise
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcus André Acioly
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlos Telles Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maurice Vincent
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emerson Leandro Gasparetto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maud Parise.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Parise, M., Acioly, M.A., Ribeiro, C.T. et al. The role of the cerebellopontine angle cistern area and trigeminal nerve length in the pathogenesis of trigeminal neuralgia: a prospective case-control study. Acta Neurochir 155, 863–868 (2013). https://doi.org/10.1007/s00701-012-1573-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-012-1573-0

Keywords

Search

Navigation