Pain Imaging pp 83-118 | Cite as

Imaging of Trigeminal Neuralgia

  • L. Pasquini
  • A. Bozzao


Trigeminal neuralgia is one of the most frequent neuropathy of the cranial nerves, whose prevalence has been reported between 0.03% and 0.3% in the general population.

This condition is a communal manifestation of several possible etiologies. The classical type of trigeminal neuralgia is defined as sudden, usually unilateral, severe, brief, stabbing recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve, with no cause other than a neurovascular compression.

Secondary trigeminal neuralgia is the term used to group a large amount of different diseases, which are alike in developing the symptoms of trigeminal neuralgia, due to an insult to the V CN which triggers the complex pathogenesis of pain. These conditions include inflammatory diseases, infections, neoplasms, autoimmune diseases, vascular diseases other than neurovascular conflict, and treatment-related disorders. Generally, the possible mechanisms which lead to the development of neuralgia include nerve distortion/compression by an external mass or damage to the nerve fibers due to an acute or chronic insult.

The radiological investigation plays a pivotal role in the diagnosis of trigeminal neuralgia, and MRI constitutes the gold imaging standard in most cases.

The trigeminal nerve is a mixed sensory-motor nerve which can be divided anatomically into five segments: brainstem segment, cisternal segment, Meckel’s cave segment, cavernous sinus segment, and extracranial segment.

In this paragraph, an anatomy-based imaging approach is proposed to investigate the many causes of trigeminal neuralgia, highlighting the importance of choosing the appropriate sequences and parameters, in the light of a target-suited protocol.


Trigeminal neuralgia Pain Neurovascular conflict Secondary neuralgia MRI 

Supplementary material

Video 6.1

Cavernous malformation of the pons displayed on T2 FLAIR weighted images. The finding is characterized by etherogeneous signal intensity due to haemorragic transformation in different phases, with hypointense core and hyperintense rim (early/late subacute bleeding) (MOV 4704 kb)

Video 6.2a

The video displays a diffuse infiltrating pontine glioma showing low-grade features: (a) lack of diffusion restriction on ADC maps (MOV 3581 kb)

Video 6.2b

The video displays a diffuse infiltrating pontine glioma showing low-grade features: (b) No signal abnormalities on DWI (MOV 10379 kb)

Video 6.2c

The video displays a diffuse infiltrating pontine glioma showing low-grade features: (c) Hyperintense signal on FLAIR images (MOV 4734 kb)

Video 6.2d

The video displays a diffuse infiltrating pontine glioma showing low-grade features: (d) No contrast enhancement on post-Gd T1 weighted images (sagittal plane). The cranial portion of the tumor invades the trigeminal nuclei at the level of the pons (MOV 5155 kb)

Video 6.2e

The video displays a diffuse infiltrating pontine glioma showing low-grade features: (e) No contrast enhancement on post-Gd T1 weighted images (axial plane). The cranial portion of the tumor invades the trigeminal nuclei at the level of the pons (MOV 3626 kb)

Video 6.2f

The video displays a diffuse infiltrating pontine glioma showing low-grade features: (f) T2 weighted images (MOV 7092 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • L. Pasquini
    • 1
  • A. Bozzao
    • 1
  1. 1.Neuroradiology Unit, NESMOS (Neuroscience, Mental Health and Sensory Organs) DepartmentSant’Andrea Hospital, La Sapienza UniversityRomeItaly

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