Computed Tomography in the Diagnosis of Classical Trigeminal Neuralgia

Objective: This study aims to characterize the pathogenesis of neurovascular conflict in trigeminal neuralgia (TN) with the goal of producing a reliable diagnostic method. Methods: Data were obtained during microvascular decompression surgery. The normal relationship between the superior cerebellar artery (SCA) and the trigeminal nerve root also was characterized in postmortem cases. Furthermore, SCA was imaged with high-resolution computed tomography angiography. Results: Our results indicate that contact between SCA and the trigeminal nerve root is present in both TN and non-TN cases, but in patients with TN, the apex of SCA loop was always at the bottom of the upper edge of the trigeminal root forming the state of neurovascular conflict. High-resolution angiography supported the intraoperative results. Conclusions: These findings indicate a clear difference between neurovascular contact and conflict and point to the use of high-resolution computed tomography visualization of the position of SCA loop apex relative to the trigeminal nerve root as a primary diagnostic method.