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Morphological and functional anatomy of the trigeminal triangular plexus as an anatomical entity: a systematic review

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Abstract

Purpose

The sensory trigeminal nerve in the trigeminal cave of Meckel—which is an individualized lodge—is classically segmented into two parts: the trigeminal ganglion (TG) and the triangular plexus (TP). The TP has been defined as the portion of the trigeminal nerve from the posterior margin of the TG to the path over the upper ridge of the petrous bone. Due to its relatively unrecognized status, its morphological and functional anatomy has been reviewed by the authors through a PRISMA systematic review of the literature.

Methods

The authors have carried out a systematic review of the TP according to the PRISMA model with various bibliographical bases. Before 1947: Medic @ Library (BIU Santé Paris, 2017); Index-Catalog of the Library of the Surgeon-General’s Office (US National Library of Medicine, 2017); Gallica (French National Library, 2017). After 1947: PUBMED, PubMed Central and MEDLINE.

Results

56 articles were retained for full-text examination, of which 23 were chosen and included. The TP was described as having a triangular shape (30.2%), a plexual organization (97.4%) with sensory-, motor- and sympathetic-anastomoses (96.7%) that, however, respect the somatotopic trigeminal distribution (93.3%). The direct electrical stimulation of the root at the level of the TP (during radiofrequency-thermorhizotomy procedures) confirmed a clear-cut somatotopy.

Conclusion

An understanding of both the morphological and the functional anatomy of the triangular plexus can contribute to accuracy and safety on the surgeries performed for trigeminal neuralgia and tumor removal inside the trigeminal cave.

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Fig. 1

Courtesy of the anatomical laboratory of Lyon university. Specimen dissected by E. Wydh, P. Mertens and M. Sindou

Fig. 2

Source gallica.bnf.fr/Bibliothèque nationale de France.


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Acknowledgements

We are indebted to Marie-Pierre Deschamps (Latin scholar) for her help. We are indebted to Fanny Leluan-Higgins (English native) for her insight and advice while reviewing the article.

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FB: project development; data collection and management; data analysis; manuscript writing/editing; reviewed final version of the manuscript and approval for submission. PM: analysis and interpretation of data; critical revision of the article; reviewed final version of the manuscript and approval for submission. MS: project development; data analysis; manuscript writing; critical revision of the article; reviewed final version of the manuscript and approval for submission.

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Correspondence to Florian Bernard.

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Bernard, F., Mercier, P. & Sindou, M. Morphological and functional anatomy of the trigeminal triangular plexus as an anatomical entity: a systematic review. Surg Radiol Anat 41, 625–637 (2019). https://doi.org/10.1007/s00276-019-02217-8

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