Neurovascular compression, the importance of radiological-clinical correlation (original) (raw)
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Neurosurgery - Cases and Reviews
Objective: Trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia are defined as neurovascular syndromes and are conditions of compression of the cranial nerves by vascular structures. The aim of this study is to make the surgical approach safer by providing aggregate data on vascular structures and their aspects that cause compression in neurovascular syndromes. Methods: We performed a retrospective analysis of 338 cases who had MVD surgery between the years 2009-2019 in our center. In this study we determine the position and anatomy of the neurovascular conflict and try to classify the vascular relation with the nerve according to operative anatomy. Results: SCA is the most common artery compressing the trigeminal nerve mostly superior, whereas AICA most commonly compress the facial nerve from the inferior of the nerve. PICA is the most common artery compressing the inferior cranial nerves from superior. We identified most of SCA compression from superior, most of AICA from inferior. We observed that compression of the inferior cranial nerves was caused by PICA, VA, and BA. Conclusions: To know the most common neurovascular compression patterns in neurovascular syndromes provide confidence and improve success in MVD surgery.
American Journal of Neuroradiology, 2016
Neurovascular compression syndromes are usually caused by arteries that directly contact the cisternal portion of a cranial nerve. Not all cases of neurovascular contact are clinically symptomatic. The transition zone between the central and peripheral myelin is the most vulnerable region for symptomatic neurovascular compression syndromes. Trigeminal neuralgia (cranial nerve V) has an incidence of 4-20/100,000, a transition zone of 4 mm, with symptomatic neurovascular compression typically proximal. Hemifacial spasm (cranial nerve VII) has an incidence of 1/100,000, a transition zone of 2.5 mm, with symptomatic neurovascular compression typically proximal. Vestibular paroxysmia (cranial nerve VIII) has an unknown incidence, a transition zone of 11 mm, with symptomatic neurovascular compression typically at the internal auditory canal. Glossopharyngeal neuralgia (cranial nerve IX) has an incidence of 0.5/100,000, a transition zone of 1.5 mm, with symptomatic neurovascular compression typically proximal. The transition zone overlaps the root entry zone close to the brain stem in cranial nerves V, VII, and IX, yet it is more distal and does not overlap the root entry zone in cranial nerve VIII. Although symptomatic neurovascular compression syndromes may also occur if the neurovascular contact is outside the transition zone, symptomatic neurovascular compression syndromes are more common if the neurovascular contact occurs at the transition zone or central myelin section, in particular when associated with nerve displacement and atrophy. ABBREVIATIONS: AICA ϭ anterior inferior cerebellar artery; CN ϭ cranial nerve; GN ϭ glossopharyngeal neuralgia; HFS ϭ hemifacial spasm; NVC ϭ neurovascular compression; NVCS ϭ neurovascular compression syndrome; REZ ϭ root entry/exit zone; TN ϭ trigeminal neuralgia; TZ ϭ transition zone From the Faculty of Medicine (
Endoscopic criteria of offending vessel in neurovascular compression syndrome
The Egyptian Journal of Otolaryngology, 2014
The aim of this work was to detect the anatomical relationship criteria of the offending vessel with respect to the cranial nerve in neurovascular compression syndrome using the endoscopicassisted minimally invasive retrosigmoid approach for microvascular decompression (MVD); these criteria help the surgeon to de ne the actual con icting vessel during surgery for better results. Conclusion Certain criteria for the anatomical relationship between the offending vessel and the affected cranial nerve should be ful lled to diagnose the actual con icting vessel during MVD surgery in vascular compression syndrome using endoscopic-assisted minimally invasive retrosigmoid approach.
Neurovascular compression in painful tic.pdf
This article describes the case of a 67-year-old woman who presented with a typical left hemifacial spasm of 8-month duration. After 2 months, she experienced lacinating and sharp shock-like pain in the left side of her face affecting the V1 and V2 territories and a discrete attenuation of nauseous reflex on the left side. CT angiography and MRI revealed significant compression of left cranial nerves V, VII, VIII, IX and X by a giant and tortuous vertebro-basilar arterial complex. This case illustrates the nonlinearity of the relationship between the presence of the stressor factor and the actual manifestation of the disease.
European Radiology, 2007
There have been unprecedented improvements in cross-sectional imaging in the last decades. The emergence of volumetric CT, higher field MR scanners and higher resolution MR sequences is largely responsible for the increasing diagnostic yield of imaging in patients presenting with cranial nerve deficits. The introduction of parallel MR imaging in combination with small surface coils allows the depiction of submillimetric nerves and nerve branches, and volumetric CT and MR imaging is able to provide high quality multiplanar and curved reconstructions that can follow the often complex course of cranial nerves. Seeking the cause of a cranial nerve deficit is a common indication for imaging, and it is not uncommon that radiologists are the first specialists to see a patient with a cranial neuropathy. To increase the diagnostic yield of imaging, high-resolution studies with smaller fields of view are required. To keep imaging studies within a reasonable time frame, it is mandatory to tailor the study according to neuro-topographic testing. This review article focuses on the contribution of current imaging techniques in the depiction of primary and secondary neoplastic conditions affecting the cranial nerves as well as on neurovascular conflicts, an increasingly recognized cause of cranial neuralgias.
Acta Neurochirurgica, 2010
Surgical outcome after microvascular decompression (MVD) for primary trigeminal neuralgia (TN) has been demonstrated as being related to the characteristics of the neurovascular compression (NVC), especially to the degree of compression exerted on the root. Therefore, preoperative determination of the NVC features could be of great value to the neurosurgeon, for evaluation of conflicting nature, exact localization, direction and degree of compression. This study deals with the predictive value of MRI in detecting and assessing features of vascular compression in 100 consecutive patients who underwent MVD for TN. The study included 100 consecutive patients with primary TN who were submitted to a preoperative 3D MRI 1.5 T with T2 high-resolution, TOF-MRA, and T1-Gadolinium. Image analysis was performed by an independent observer blinded to the operative findings and compared with surgical data. In 88 cases, image analysis showed NVC features that coincided with surgical findings. There were no false-positive results. Among 12 patients that did not show NVC at image analysis, nine did not have NVC at intraoperative observation, resulting in three false-negative cases. MRI sensitivity was 96.7% (88/91) and specificity 100% (9/9). Image analysis correctly identified compressible vessel in 80 of the 91 cases and degree of compression in 77 of the 91 cases. Kappa-coefficient predicting degree of root compression was 0.746, 0.767, and 0.86, respectively, for Grades I (simple contact), II (distortion), and III (marked indentation; p < 0.01). 3D T2 high-resolution in combination with 3D TOF-MRA and 3D T1-Gadolinium proved to be reliable in detecting NVC and in predicting the degree of the root compression.
Neurovascular compression and essential hypertension
Neuroradiology, 1991
The pathogenesis of essential hypertension still remains unclear. Recently, it has been supposed, that an arterial compression of the left root entry zone (REZ) of the cranial nerves IX and X by looping arteries may play a pathogenetic role. In this report we verified this hypothesis retrospectively by vertebral angiographies in 99 hypertensive and 57 normotensive patients. The angiographic findings were compared with the results obtained from an anatomic study, in which the positions of 10 left vagus/glossopharyngeal nerves in the skull were radiographically determined in 10 cadavers. By using a pattern of REZ topography developed from this information we obtained the following results: In 81% of the evaluable angiographies of hypertensive patients we found an artery in the left REZ of cranial nerves IX and X. The normotensive patients showed an artery in the REZ only in 41.7% of cases. Our results support the hypothesis that essential hypertension may be combined with neurovascular compression of the left REZ of cranial nerves IX/X.
SUNCT/SUNA and neurovascular compression: New cases and critical literature review
Cephalalgia, 2013
Background: Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with cranial autonomic symptoms (SUNA) are primary headache syndromes. A growing body of literature has focused on brain magnetic resonance imaging (MRI) evidence of neurovascular compression in these syndromes. Objective: The objective of this article is to assess whether SUNCT is a subset of SUNA or whether the two are separate syndromes and clarify the role of neurovascular compression. Method: We describe three new SUNCT cases with MRI findings of neurovascular compression and critically review published SUNCT/SUNA cases. Results: We identified 222 published SUNCT/SUNA cases. Our three patients with neurovascular compression added to the 34 cases previously described (16.9%). SUNCT and SUNA share the same clinical features and therapeutic options. At present, there is no available abortive treatment for attacks. Lamotrigine was effective in 64% of patients; topiramate and gabapentin in about one-third of cases. Of the 34 cases with neurovascular compression, seven responded to drug therapies, 16 patients underwent microvascular decompression of the trigeminal nerve (MVD) with effectiveness in 75%. Conclusions: We suggest that SUNCT and SUNA should be considered clinical phenotypes of the same syndrome. Brain MRI should always be performed with a dedicated view to exclude neurovascular compression. The high percentage of remission after MVD supports the pathogenetic role of neurovascular compression.