The evaluation of neurovascular relationships in trigeminal neuralgia: a pilot study on the optimal combination of high-resolution three-dimensional MR sequences

Background: to explore the efficacy and optimal modality of three-dimensional (3d) mri sequences in the preoperative detection of neurovascular compressions (nvcs) in patients with trigeminal neuralgia (tn). materials and methods: forty-nine cases of typical unilateral tn had undergone 3d time-of-flight magnetic resonance angiography (3d-tof mra), 3d fast imaging employing steady-state acquisition (3d-fiesta), and contrast-enhanced 3d spoiled gradient-recalled sequence (3d-spgr) on a 3 tesla mr scanner. neurovascular relationships (including neurovascular contact and position and the nature of the offending vessels) on mr images were reviewed by a neuroradiologist who was unaware of the clinical findings. subsequently, microvascular decompression (mvd) surgery was performed on all patients. comparison was made between the imaging results and surgical findings. results: mvd verified nvc in 48 (98%) symptomatic nerves, while 3d-tof mra, 3d-fiesta, and 3d-spgr revealed nvc in 38 (78%), 48 (98%), and 47 (96%) cases, respectively. agreement between the position of nvc, as defined by 3d-fiesta (κ = 0.86) or 3dspgr (κ = 0.83) and surgical findings, was excellent. moreover, excellent agreement was confirmed between the nature of compressing vessels as defined by 3d-fiesta in combination with 3d-tof mra (κ = 0.95) or contrast-enhanced 3d-spgr in combination with 3d-tof mra (κ = 0.92) and surgical findings. conclusions: nvcs were visualized with good sensitivity and specificity with 3d mri sequences in tn. we propose that 3d-fiesta combined with 3d-tof mra is a safe, convenient, and efficacious mri sequence for revealing nvcs and is crucial for the preoperative diagnosis and surgical planning of mvd.