Use of High-Resolution Magnetic Resonance Imaging (MRI) for Radiological Diagnosis of Neurovascular Conflict: A Case Report

Case series Patients: Male, 77-year-old • Female, 58-year-old Final Diagnosis: Neurovascular conflict Symptoms: Trigeminal neuralgia Medication: Carbamazepine Clinical Procedure: Magnetic resonance imaging (MRI) • retrosigmoid craniotomy and microvascular decompressio Specialty: Radiology • Neurosurgery OBJECTIVE: Rare disease BACKGROUND: Neurovascular conflict (NVC) or neurovascular compression syndrome is a pathoanatomical phenomenon that puts the vessel and the cranial nerve in direct contact, resulting in mechanical irritation to the nerve. Several clinical syndromes in which abnormal activity spreads in the nerve innervation zone are known to be associated with neurovascular compression syndrome. Radiological examination and precise diagnostic measures are the cornerstones for successful diagnosis, but a precise diagnosis of NVC is not always easily achievable. Apart from routine radiological examination, additional diagnostic tools should be used, including high-resolution, three-dimensional (3D), T2-weighted (T2W) magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and precise diagnostic radiological criteria. CASE REPORTS: We present the cases of 2 patients diagnosed with trigeminal neuralgia V2/3 and severe facial pain for more than 5 years for whom treatment with medication was unsuccessful. Their primary MRI scans did not show specific signs of possible NVC. For clarification, additional high-resolution, T2W MRI scans were performed. Radiological evidence of NVC was found. During neurosurgery, an NVC was confirmed among the trigeminal nerve, the roots of the cerebellum, and the petrosal vein. The procedure was successful in both patients. CONCLUSIONS: High-resolution, T2W MRI sequences together with 3D MRA (TOF-MRA) are the most sensitive tools available for detection of cranial nerve root entrance area vascular compression. The best way that radiologists can increase the accuracy of diagnosis of NVC is to take a systematic approach to evaluation and to apply the recommended criteria to images from patients suspected of having the condition.