Acta Neurochirurgica

, Volume 154, Issue 9, pp 1627–1633 | Cite as

Patients with idiopathic trigeminal neuralgia have a sharper-than-normal trigeminal-pontine angle and trigeminal nerve atrophy

  • Seung Man Ha
  • Sang Heum Kim
  • Eun Hye Yoo
  • In-bo Han
  • Dong-A Shin
  • Kyung Gi Cho
  • Sang Sup Chung
  • Young Seok Park
Clinical Article



Trigeminal neuralgia (TN) is primarily diagnosed by symptoms and patient history. Magnetic resonance (MR) imaging can be helpful in visualizing the neurovascular compression of the trigeminal nerve in TN patients, but the current parameters used as diagnostic markers for TN are less than optimal. The aim of this study is to assess whether the angle between the trigeminal nerve and the pons (the trigeminal-pontine angle) on the affected side of patients with idiopathic TN differs from that of the unaffected side and that found in controls without TN.


A case-control study of 30 clinically diagnosed idiopathic TN patients aged 30 to 79 years and 30 age- and sex-matched controls was conducted. We compared the trigeminal-pontine angle and trigeminal nerve atrophy via fast-imaging employing steady-state acquisition (FIESTA) MR imaging.


A sharp trigeminal-pontine angle was observed in 25 patients (25/30) on the affected side. As such, the mean angle of the trigeminal nerve on the affected side (40.17) was significantly smaller than that on the unaffected side (48.91, p = 0.001) and that in the control group (52.02, p < 0.001).


A sharp trigeminal-pontine angle on the affected side was found in idiopathic TN patients by FIESTA imaging. This suggests that a sharp trigeminal-pontine angle increases the chance of neurovascular compression on the medial side of the trigeminal nerve.


Trigeminal neuralgia Magnetic resonance imaging Atrophy Trigeminal nerve 



The authors would like to thank Hye Young Yu (R.N.), Ju-Mi Kim (R.N.), and Hyouk Sang Kwon (BS) for data acquisition.

Disclosure of Funding


Financial Support and Industry Affiliations


Conflict of Interest


Supplementary material

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High resolution image (TIFF 437 kb)


  1. 1.
    Adamczyk M, Bulski T, Sowinska J, Furmanek A, Bekiesinska-Figatowska M (2007) Trigeminal nerve—artery contact in people without trigeminal neuralgia—MR study. Medical science monitor: international medical. J Exp Clin Res 13(Suppl 1):38–43Google Scholar
  2. 2.
    Akimoto H, Nagaoka T, Nariai T, Takada Y, Ohno K, Yoshino N (2002) Preoperative evaluation of neurovascular compression in patients with trigeminal neuralgia by use of three-dimensional reconstruction from two types of high-resolution magnetic resonance imaging. Neurosurgery 51:956–961, discussion 961–952PubMedGoogle Scholar
  3. 3.
    Chavez GD, De Salles AA, Solberg TD, Pedroso A, Espinoza D, Villablanca P (2005) Three-dimensional fast imaging employing steady-state acquisition magnetic resonance imaging for stereotactic radiosurgery of trigeminal neuralgia. Neurosurgery 56:E628, discussion E628PubMedCrossRefGoogle Scholar
  4. 4.
    El-Ghandour NM (2010) Microvascular decompression in the treatment of trigeminal neuralgia caused by vertebrobasilar ectasia. Neurosurgery 67:330–337PubMedCrossRefGoogle Scholar
  5. 5.
    Erbay SH, Bhadelia RA, O’Callaghan M, Gupta P, Riesenburger R, Krackov W, Polak JF (2006) Nerve atrophy in severe trigeminal neuralgia: noninvasive confirmation at MR imaging–initial experience. Radiology 238:689–692PubMedCrossRefGoogle Scholar
  6. 6.
    Gudmundsson K, Rhoton AL Jr, Rushton JG (1971) Detailed anatomy of the intracranial portion of the trigeminal nerve. J Neurosurg 35:592–600PubMedCrossRefGoogle Scholar
  7. 7.
    Hatipoglu HG, Durakoglugil T, Ciliz D, Yuksel E (2007) Comparison of FSE T2W and 3D FIESTA sequences in the evaluation of posterior fossa cranial nerves with MR cisternography. Diagn Interv Radiol 13:56–60PubMedGoogle Scholar
  8. 8.
    Herweh C, Kress B, Rasche D, Tronnier V, Troger J, Sartor K, Stippich C (2007) Loss of anisotropy in trigeminal neuralgia revealed by diffusion tensor imaging. Neurology 68:776–778PubMedCrossRefGoogle Scholar
  9. 9.
    Horinek D, Brezova V, Nimsky C, Belsan T, Martinkovic L, Masopust V, Vrana J, Kozler P, Plas J, Krysl D, Varjassyova 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) 151:669–675CrossRefGoogle Scholar
  10. 10.
    Hutchins LG, Harnsberger HR, Jacobs JM, Apfelbaum RI (1990) Trigeminal neuralgia (tic douloureux): MR imaging assessment. Radiology 175:837–841PubMedGoogle Scholar
  11. 11.
    Hyun SJ, Kong DS, Park K (2010) Microvascular decompression for treating hemifacial spasm: lessons learned from a prospective study of 1,174 operations. Neurosurg Rev 33:325–334, discussion 334PubMedCrossRefGoogle Scholar
  12. 12.
    Kamiguchi H, Ohira T, Ochiai M, Kawase T (1997) Computed tomographic analysis of hemifacial spasm: narrowing of the posterior fossa as a possible facilitating factor for neurovascular compression. J Neurol Neurosurg Psychiatry 62:532–534PubMedCrossRefGoogle Scholar
  13. 13.
    Kress B, Rasche D, Fiebach J, Tronnier V, Sartor K, Stippich C (2004) MR volumetry of the trigeminal nerve in patients with unilateral facial pain. RoFo: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 176:719–723PubMedCrossRefGoogle Scholar
  14. 14.
    Kress B, Schindler M, Rasche D, Hahnel S, Tronnier V, Sartor K, Stippich C (2005) MRI volumetry for the preoperative diagnosis of trigeminal neuralgia. Eur Radiol 15:1344–1348PubMedCrossRefGoogle Scholar
  15. 15.
    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). Neuro-Chirurgie 56:43–49PubMedGoogle Scholar
  16. 16.
    Leal PR, Hermier M, Froment JC, Souza MA, Cristino-Filho G, Sindou M (2010) Preoperative demonstration of the neurovascular compression characteristics with special emphasis on the degree of compression, using high-resolution magnetic resonance imaging: a prospective study, with comparison to surgical findings, in 100 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Acta Neurochir (Wien) 152:817–825CrossRefGoogle Scholar
  17. 17.
    Merskey H, Bogduk N (1994) Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. IASP Press, Seatle, WA, 59–71Google Scholar
  18. 18.
    Mikami T, Minamida Y, Yamaki T, Koyanagi I, Nonaka T, Houkin K (2005) Cranial nerve assessment in posterior fossa tumors with fast imaging employing steady-state acquisition (FIESTA). Neurosurg Rev 28:261–266PubMedCrossRefGoogle Scholar
  19. 19.
    Miller JP, Acar F, Hamilton BE, Burchiel KJ (2009) Radiographic evaluation of trigeminal neurovascular compression in patients with and without trigeminal neuralgia. J Neurosurg 110:627–632PubMedCrossRefGoogle Scholar
  20. 20.
    Okumura Y, Suzuki M, Takemura A, Tsujii H, Kawahara K, Matsuura Y, Takada T (2005) Visualization of the lower cranial nerves by 3D-FIESTA. Nihon Hoshasen Gijutsu Gakkai zasshi 61:291–297PubMedGoogle Scholar
  21. 21.
    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 110:633–637PubMedCrossRefGoogle Scholar
  22. 22.
    Peker S, Dincer A, Necmettin Pamir M (2009) Vascular compression of the trigeminal nerve is a frequent finding in asymptomatic individuals: 3-T MR imaging of 200 trigeminal nerves using 3D CISS sequences. Acta Neurochir (Wien) 151:1081–1088CrossRefGoogle Scholar
  23. 23.
    Rasche D, Kress B, Stippich C, Nennig E, Sartor K, Tronnier VM (2006) Volumetric measurement of the pontomesencephalic cistern in patients with trigeminal neuralgia and healthy controls. Neurosurgery 59:614–620, discussion 614–620PubMedCrossRefGoogle Scholar
  24. 24.
    Sheth S, Branstetter BFT, Escott EJ (2009) Appearance of normal cranial nerves on steady-state free precession MR images. Radiographics: a review publication of the Radiological Society of North America, Inc. 29:1045–1055Google Scholar
  25. 25.
    Sindou M, Howeidy T, Acevedo G (2002) Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia (with correlations between topography of pain and site of the neurovascular conflict). Prospective study in a series of 579 patients. Acta Neurochir (Wien) 144:1–12, discussion 12–13CrossRefGoogle Scholar
  26. 26.
    Tan EK, Chan LL (2004) Clinico-radiologic correlation in unilateral and bilateral hemifacial spasm. J Neurol Sci 222:59–64PubMedCrossRefGoogle Scholar
  27. 27.
    Vergani F, Panaretos P, Penalosa A, English P, Nicholson C, Jenkins A (2011) Preoperative MRI/MRA for microvascular decompression in trigeminal neuralgia: consecutive series of 67 patients. Acta Neurochir(Wien) 153(12):2377–2381Google Scholar
  28. 28.
    Xie T, Zhang XB, Yun H, Hu F, Yu Y, Gu Y (2011) 3D-FIESTA MR images are useful in the evaluation of the endoscopic expanded endonasal approach for midline skull-base lesions. Acta Neurochir (Wien) 153:12–18CrossRefGoogle Scholar
  29. 29.
    Yoshino N, Akimoto H, Yamada I, Nagaoka T, Tetsumura A, Kurabayashi T, Honda E, Nakamura S, Sasaki T (2003) Trigeminal neuralgia: evaluation of neuralgic manifestation and site of neurovascular compression with 3D CISS MR imaging and MR angiography. Radiology 228:539–545PubMedCrossRefGoogle Scholar
  30. 30.
    Yousry I, Camelio S, Schmid UD, Horsfield MA, Wiesmann M, Bruckmann H, Yousry TA (2000) Visualization of cranial nerves I-XII: value of 3D CISS and T2-weighted FSE sequences. Eur Radiol 10:1061–1067PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Seung Man Ha
    • 1
  • Sang Heum Kim
    • 2
  • Eun Hye Yoo
    • 2
  • In-bo Han
    • 1
  • Dong-A Shin
    • 1
  • Kyung Gi Cho
    • 1
  • Sang Sup Chung
    • 1
  • Young Seok Park
    • 1
  1. 1.Department of NeurosurgeryBundang CHA Medical Center, CHA University College of MedicineSeongnamKorea
  2. 2.Department of NeuroradiologyBundang CHA Medical Center, CHA University College of MedicineSeongnamKorea

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