High-resolution MRI findings following trigeminal rhizotomy

B. G. Northcutt, D. P. Seeburg, J. Shin, Nafi Aygun, Daniel Herzka, D. Theodros, C. R. Goodwin, Chetan Bettegowda, Michael Lim, Ari M Blitz

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE: Patients with trigeminal neuralgia often undergo trigeminal rhizotomy via radiofrequency thermocoagulation or glycerol injection for treatment of symptoms. To date, radiologic changes in patients with trigeminal neuralgia post-rhizotomy have not been described, to our knowledge. The aim of this study was to evaluate patients after trigeminal rhizotomy to characterize post-rhizotomy changes on 3D high-resolution MR imaging. MATERIALS AND METHODS: A retrospective review of trigeminal neuralgia protocol studies was performed in 26 patients after rhizotomy compared with 54 treatment-naïve subjects with trigeminal neuralgia. Examinations were reviewed independently by 2 neuroradiologists blinded to the side of symptoms and treatment history. The symmetry of Meckel's cave on constructive interference in steadystate and the presence of contrast enhancement within the trigeminal nerves on volumetric interpolated breath-hold examination images were assessed subjectively. The signal intensity of Meckel's cave was measured on coronal noncontrast constructive interference in steady-state imaging on each side. RESULTS: Post-rhizotomy changes included subjective clumping of nerve roots and/or decreased constructive interference in steadystate signal intensity within Meckel's cave, which was identified in 17/26 (65%) patients after rhizotomy and 3/54 (6%) treatment-naïve patients (P=.001). Constructive interference in steady-state signal intensity within Meckel's cave was, on average, 13% lower on the side of the rhizotomy in patients posttreatment compared with a 1% difference in controls (P=.001). Small regions of temporal encephalomalacia were noted in 8/26 (31%) patients after rhizotomy and 0/54 (0%) treatment-naïve patients (P=.001). CONCLUSIONS: Post-trigeminal rhizotomy findings frequently include nerve clumping and decreased constructive interference in steady-state signal intensity in Meckel's cave. Small areas of temporal lobe encephalomalacia are encountered less frequently.

Original languageEnglish (US)
Pages (from-to)1920-1924
Number of pages5
JournalAmerican Journal of Neuroradiology
Volume37
Issue number10
DOIs
StatePublished - Oct 1 2016

Keywords

  • CISS=constructive interference in steady-state
  • SI=signal intensity
  • SPACE=sampling perfection with application-optimized contrasts by using different flip angle evolution
  • VIBE=volumetric interpolated breath-hold examination

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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    Northcutt, B. G., Seeburg, D. P., Shin, J., Aygun, N., Herzka, D., Theodros, D., Goodwin, C. R., Bettegowda, C., Lim, M., & Blitz, A. M. (2016). High-resolution MRI findings following trigeminal rhizotomy. American Journal of Neuroradiology, 37(10), 1920-1924. https://doi.org/10.3174/ajnr.A4868