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. 2022 Oct;52(5):1627-1638.
doi: 10.55730/1300-0144.5503. Epub 2022 Oct 19.

Morphometric examination of trigeminal nerve and its adjacent structures in patients with trigeminal neuralgia: a case-control study

Yunus Emre Kundakçı  1 , Nadire Ünver Doğan  2 , İnci Kara  3 , Mehmet Öztürk  3 , Zeliha Fazlıoğulları  2 , Ahmet Kağan Karabulut  2
Affiliations

Morphometric examination of trigeminal nerve and its adjacent structures in patients with trigeminal neuralgia: a case-control study

Yunus Emre Kundakçı et al. Turk J Med Sci. 2022 Oct.

Abstract

Background: Morphological differences that can lead the trigeminal nerve to neurovascular conflict and a new solitary pontine lesion are associated with the pathogenesis of trigeminal neuralgia (TN). In this case-control study, we aimed to contribute to the current discussions about the pathogenesis of TN by investigating the anatomical structures that may have an effect on the morphometric parameters of the trigeminal nerve.

Methods: This study included 25 patients with TN followed up for pain in the Department of Algology, Faculty of Medicine, and 25 age- and gender-matched controls. We performed morphometric measurements including the length and volume of the trigeminal nerve, cerebellopontine cistern, pons, and posterior fossa in the MRIs of these individuals. Comparative analyses were performed for the mean of the affected and unaffected sides of the TN patients and the right, left, and both sides of the control group.

Results: In patients with TN, on the affected side, length and volume of the trigeminal nerve and cerebellopontine cistern volume were found smaller than controls (p < 0.05). Pons volume was higher in patients with TN compared to controls (p < 0.05). The length of the affected nerve was significantly related to prepontine cistern length and cerebellopontine cistern volume (p < 0.05).

Discussion: The cerebellopontine cistern volume has a significant impact on the morphometric characteristics of the trigeminal nerve. Especially, whether the increase in the volume of pons causes a decrease in the volume of cerebellopontine cistern should be clarified with further research.

Keywords: Trigeminal neuralgia; anatomy; brain stem; facial pain; morphometry.

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Figures

Figure 1
Figure 1
Flow diagram of the study. 3D MRI; three-dimensional magnetic resonance imaging, MS; multiple sclerosis.
Figure 2
Figure 2
The figure shows the limits used in the evaluation of morphometric length measurements (cm) on T1-weighted MRI scans in a 39-year-old female patient with TN. (A); trigeminal nerve length (blue draws), (B); nerve-to-nerve distance (yellow draw), (C); anterior-posterior prepontine cistern length (red draw).
Figure 3
Figure 3
The figure shows the exemplary anatomical limit of the brain structures evaluated for volume measurements (cm3) on T1-weighted MRI scans in a 39-year-old female patient with TN. All volume measurements were automatically calculated on images transferred to a postprocessing Workstation (syngo.via version VB30A, Siemens Healthcare). (A); trigeminal nerve volume (blue area), (B); cerebellopontine cistern volume (yellow and green areas). (C); pons volume (pink area), (D); posterior fossa volume (green area).
Figure 4
Figure 4
The correlation scatter plots. (A) Correlation of the difference in the affected and unaffected lengths of the cisternal segments of the trigeminal nerves with symptom duration (r = 0.069, p = 0.744). (B) Correlation of the difference in the affected and unaffected volumes of the cisternal segments of the trigeminal nerves with symptom duration (r = −0.058, p = 0.784).
Figure 5
Figure 5
Comparison of the affected (n = 25) and unaffected (unaffected) sides (n = 25) of TN patients with the mean values of the right and left (n = 50) total of the control group. (A) The length of cisternal segment of the trigeminal nerve (cm), (B) The volume of cisternal segment of the trigeminal nerve (cm3), (C) The volume of the cerebellopontine cistern (cm3). * Statistical significance at the p < 0.05 level. NS, not significant.
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