Vascular Compression Research Articles

Penetrating Offenders in Hemifacial Spasm: Surgical Tactics and Prognosis.

(1) Background: In cases of hemifacial spasm (HFS), there are various patterns related to the vascular compression of the facial nerve, including a very rare form that is seen when the offending vessel penetrates the facial nerve. However, there have been few reports in the literature regarding the associated surgical techniques and postoperative prognosis. (2) Methods: A retrospective review was conducted of 4755 patients who underwent microvascular decompression (MVD) surgery from April 1997 to June 2023. In total, 8 out of the 4755 patients (0.2%) exhibited a penetrating offending vessel; the medical and surgical records of these 8 patients were then analyzed. Surgery was then attempted to maximally decompress the penetrating offender. (3) Results: Seven out of the eight patients (87.5%) were spasm-free immediately after surgery, and one had only 10% residual spasm compared to their preoperative condition. That patient was also spasm-free one year later. Postoperative facial palsy occurred in one patient (12.5%) who was assessed as grade II in the House-Brackmann grading system. In another patient, the resection of a small facial nerve bundle did not result in facial palsy. There were no cases of hearing loss or other complications. (4) Conclusions: Decompressing the penetrating offender did not increase the incidence of facial palsy, and the prognosis for hemifacial spasms was good. Therefore, when a penetrating pattern was encountered during MVD surgery, decompression between the penetrating offender and the facial nerve may offer good results.

Minimally Invasive Retrosigmoidal Parasterional Burr-Hole Approach: Technique and Neuropathic Pain Amelioration after Microvascular Decompression of the Trigeminal Nerve.

Trigeminal neuralgia, a common condition in clinical practice, often occurs due to vascular compression caused by aberrant or ectopic arterial or venous vessels. Microvascular decompression through a minimally invasive retrosigmoidal approach has shown high rates of pain control, low complication rates, and excellent therapeutic results. To describe the surgical technique and clinical outcomes in terms of pain relief after microvascular decompression of the trigeminal nerve through a minimally invasive retrosigmoidal parasterional burr-hole technique. A group of patients with trigeminal neuralgia refractory to medical management who underwent microvascular decompression were examined. The records of the patients were considered retrospectively (2016-2018), and the outcomes were considered based on the Visual Analogue Scale (VAS) and the Barrow Neurological Institute Pain Scale (BNIPS) added to a technical note of the surgical technique for a minimally invasive retrosigmoidal parasterional burr-hole. Twenty-two patients were evaluated, and clinical assessment after surgical intervention showed a decrease in pain according to the VAS, resulting from an average preoperative state of 9.5 ± 0.37 to a postoperative condition of 1.32 ± 1.28, exhibiting statistically significant changes (p < 0.0001, d = 9.356). On the other hand, in relation to the BNIPS scale, a decrease from an average preoperative status of 4.55 ± 0.25 to a postoperative status at 12 months of 1.73 ± 0.54 was also demonstrated, showing significant changes (p < 0.0001, d = 3.960). Microvascular decompression of the trigeminal nerve through a minimally invasive retrosigmoidal parasterional burr-hole is feasible and can be a safe and effective technique for the management of pain. However, further research employing larger sample sizes and longer follow-up periods is necessary.

Proteomic Analysis to Identify Prospective Biomarkers of Treatment Outcome After Microvascular Decompression for Trigeminal Neuralgia: A Preliminary Study

Trigeminal neuralgia (TN) is a severe neuropathic facial pain disorder, often caused by vascular or neuronal compression of the trigeminal nerve. In such cases, microvascular decompression (MVD) surgery can be used to treat TN, but pain relief is not guaranteed. The molecular mechanisms that affect treatment response to MVD are not well understood. In this exploratory study, we performed label-free quantitative proteomic profiling of plasma and cerebrospinal fluid samples from patients undergoing MVD for TN, then compared the proteomic profiles of patients graded as responders (n = 7) versus non-responders (n = 9). We quantified 1,090 proteins in plasma and 1,087 proteins in the cerebrospinal fluid, of which 12 were differentially regulated in the same direction in both sample types. Functional analyses of differentially regulated proteins in protein-protein interaction networks suggested pathways of the immune system, axon guidance, and cellular stress response to be associated with response to MVD. These findings suggest potential biomarkers of response to MVD, as well as possible mechanisms of variable treatment success in TN patients. PerspectiveThis exploratory study evaluates proteomic profiles in plasma and cerebrospinal fluid of patients undergoing microvascular decompression surgery for trigeminal neuralgia. Differential expression of proteins between surgery responders versus non-responders may serve as biomarkers to predict surgical success and provide insight into surgical mechanisms of pain relief in trigeminal neuralgia.

Update on Radiotherapy Changes of Nasopharyngeal Carcinoma Tumor Microenvironment.

The utilization of radiotherapy (RT) serves as the principal approach for managing nasopharyngeal carcinoma (NPC). Consequently, it is imperative to investigate the correlation between the radiation microenvironment and radiation resistance in NPC. PubMed and China National Knowledge Infrastructure (CNKI) databases were accessed to perform a search utilizing the English keywords "nasopharyngeal cancer", "radiotherapy", and "microenvironment". The search time spanned from the establishment of the database until January 20, 2023. A total of 82 articles were included. The post-radiation tumor microenvironment (TME), or the radiation microenvironment, includes several components, such as the radiation-immune microenvironment and the radiation-hypoxic microenvironment. The radiation-immune microenvironment includes various factors like immune cells, signaling molecules, and extracellular matrix. RT can reshape the TME, leading to immune responses with both cytotoxic effects (T cells, B cells, natural killer (NK) cells) and immune escape mechanisms (regulatory T cells (Tregs), macrophages). RT enhances immune responses through DNA release, type I interferons, and immune cell recruitment. Radiation-hypoxic microenvironment affects metabolism and molecular changes. RT-induced hypoxia causes vascular changes, fibrosis, and vessel compression, leading to tissue hypoxia. Hypoxia activates hypoxia-inducible factor (HIF)-1α/2α, promoting angiogenesis and glycolysis in tumor cells. TME changes due to hypoxia also involve immune suppressive cells like myeloid-derived suppressor cells (MDSCs), tumor-associated macrophages (TAMs), and Tregs. The radiation microenvironment is involved in radiation resistance and holds a significant effect on the prognosis of patients with NPC. Exploring the radiation microenvironment provides new insights into RT and NPC research.

Single-center review on safety of biodegradable airway stenting in pediatric population.

Tracheobronchomalacia (TBM) and airway stenosis are recognized etiologies of airway obstruction among children. Their management is often challenging, requiring multiple interventions and prolonged respiratory support with associated long-term morbidity. Metallic or silicone stents have been used with mixed success and high complication rates. More recently biodegradable Ella stents (BES) provided an attractive interventional option. We report our experience in the treatment of TBM and vascular airway compression using BES. We deliberately downsized them to minimize intraluminal granulation tissue formation. Retrospective study over an 8-year period between November 2012 and December 2020 of pediatric patients with severe airway obstruction requiring airway stenting for extubation failure, malacic death spells, recurrent chest infections, or lung collapse. Thirty-three patients (5 tracheal and 28 bronchial diseases) required 55 BES during the study period. The smallest patient weighed 1.8 kg. Median age of patient at first stent implantation was 13.1 months (IQR 4.9-58.3). The majority of the bronchial stents were in the left main bronchus (93%), of which 57% for vascular compression. Repeat stents were used in 19 patients (57.7%), with a range of two to four times. We did not experience erosion, infection, or obstructive granuloma needing removal by forceps or lasering. Three stent grid occluded with secretions needing bronchoscopic lavage. Stent migration occurred in three patients. BES holds promise as a treatment option with low rate of adverse effects for a specific subset of pediatric patients with airway malacia or vascular compression. Further studies are warranted.

The Sagittal Angle of the Trigeminal Nerve at the Porus Trigeminus is a Radiologic Predictor of Surgical Outcome in Microvascular Decompression for Classical Trigeminal Neuralgia.

Classical trigeminal neuralgia (cTN) is a painful disease. Microvascular decompression (MVD) provides immediate and durable relief in many patients. A variety of positive and negative prognostic biomarkers for MVD have been identified. The sagittal angle of the trigeminal nerve at the porus trigeminus (SATNaPT) is an MRI biomarker that can identify a subset of patients with cTN whose trigeminal nerve anatomy is different from normal controls. The purpose of this case-control study was to determine whether an abnormally hyperacute SATNaPT is a negative prognostic biomarker in patients with cTN undergoing MVD. Preoperative MRIs from 300 patients with cTN who underwent MVD were analyzed to identify patients with a hyperacute SATNaPT (defined as less than 3 SDs below the mean). The rate of surgical success (pain-free after at least 12 months) was compared between patients with a hyperacute SATNaPT and all other patients. Patients without a hyperacute SATNaPT had an 82% likelihood of surgical success, whereas patients with a hyperacute SATNaPT had a 58% likelihood of surgical success ( P < .05). Patients with a hyperacute SATNaPT who also had no evidence of vascular compression on preoperative MRI had an even lower likelihood of success (29%, P < .05). In patients with cTN being considered for MVD, a hyperacute SATNaPT is a negative prognostic biomarker that predicts a higher likelihood of surgical failure. Patients with a hyperacute SATNaPT, particularly those without MRI evidence of vascular compression, may benefit from other surgical treatments or a modification of MVD to adequately address the underlying cause of cTN.

Percutaneous balloon compression for trigeminal neuralgia due to the primitive trigeminal artery: A case report and review of the literature

Trigeminal neuralgia (TN) is often caused by vascular compression of the trigeminal nerve cisternal segment. TN due to the primitive trigeminal artery formed by developmental variants of cerebral vessels is rare. We report here a 59-year-old male with TN whose preoperative MRI showed a primitive trigeminal artery that compressed the trigeminal nerve, and microvascular decompression (MVD) was performed to separate the vessel from the trigeminal nerve cisternal segment. The pain was relieved after MVD, but it recurred two months later. MRI reexamination showed that although MVD relieved the vascular compression of the trigeminal nerve cisternal segment, the nerve in the Meckel’s cave was still compressed by PTA, which was thought to be the cause of TN recurrence. Due to the limitations of the surgical microscope view, completing the vascular decompression at the Meckel’s cave is challenging. So percutaneous balloon compression was performed. After the procedure, the TN subsided. The patient remained pain free at one year follow-up. To our knowledge, this is the first case of primitive trigeminal artery-associated TN treated by percutaneous balloon compression. This case suggests that percutaneous balloon compression may be considered for TN caused by compression of the primitive trigeminal artery when MVD is difficult to perform.

Trigeminal Neuralgia as a Primary Demyelinating Disease: Potential Multimodal Evidence and Remaining Controversies

Trigeminal neuralgia is a heterogeneous disorder with likely multifactorial and complex etiology; however, trigeminal nerve demyelination and injury are observed in almost all patients with trigeminal neuralgia. The current management strategies for trigeminal neuralgia primarily involve anticonvulsants and surgical interventions, neither of which directly address demyelination, the pathological hallmark of trigeminal neuralgia, and treatments targeting demyelination are not available. Demyelination of the trigeminal nerve has been historically considered a secondary effect of vascular compression, and as a result, trigeminal neuralgia is not recognized nor treated as a primary demyelinating disorder. In this article, we review the evolution of our understanding of trigeminal neuralgia and provide evidence to propose its potential categorization, at least in some cases, as a primary demyelinating disease by discussing its course and similarities to multiple sclerosis, the most prevalent central nervous system demyelinating disorder. This proposed categorization may provide a basis in investigating novel treatment modalities beyond the current medical and surgical interventions, emphasizing the need for further research into demyelination of the trigeminal sensory pathway in trigeminal neuralgia. PerspectiveThis article proposes trigeminal neuralgia as a demyelinating disease, supported by histological, clinical, and radiological evidence. Such categorization offers a plausible explanation for controversies surrounding trigeminal neuralgia. This perspective holds potential for future research and developing therapeutics targeting demyelination in the condition.

Association Of Neuropathic Pain Improvement And hs-CRP Changes Among Trigeminal Neuralgia Patients Experienced Radiofrequency Ablation 60o and 65o Celcius: 6 months follow up

INTRODUCTION: Trigeminal neuralgia (NT) is a neuropathic pain that involves the trigeminal nerve in the face. The first-line medical management of patients with NT is Carbamazepine (CBZ). Radiofrequency ablation (RFA) procedure is a minimally invasive procedure using a high-frequency current-generating device that produced heat ablate of C-fibers with effectiveness around 76% for 10 yeas follow-up. Inflammed trigeminal nerve (TG) or the branch(es) might be one of the underlying mechanisms unless vascular compression is a common etiology. The heat effects might be according to the temperature set up varies recently from 60°C to 95°C. METHOD: This observational study enrolled 75 severe NT subjects without satisfactory improvement of treatments, divided into 3 groups: analgesics prescription (Control), RFA 60, and RFA 65 Groups. The LANSS scores and hs-CRP levels were followed-up before (baseline), 2 weeks, 3, and 6 months experienced the treatments. Subjects ages in the range of 48.32 + 12.73 to 50.88 + 14.59 years old, and the duration of illness from 4.48 to 10.32 months. RESULT: The LANSS score &gt;12 before treatments showed significance improvements (p&lt;0.001), as in the Control (64% with neuropathic pain), RFA 60 (100% with neuropathic pain), and RFA 65 group (92% with nociceptive pain) at 2 weeks followed-up. At 3 and 6 months observed 100% subjects with nociceptive pain but without significancies. Even though the hs-CRP levels observed reduced for all groups, especially RFA 60 and RFA 65, but have no significances. CONCLUSION: The LANSS scores changes observed significant improvement in all groups, which mentioned if the neuropathic pain syndromes might be better under each treatment. The Hs-CRP levels improvement is better in the neuro ablation groups than analgesic drugs treatment. Even though the Hs-CRP are following of systemic nonspecific inflammation, NT is a focal inflammation.

Trigeminal Neuralgia as An Atypical Manifestation of Intracranial Hypertension. Case Report and Literature Review

Trigeminal neuralgia, a chronic neuropathic pain, is characterized by frequent episodes of stabbing facial pain, in the territory of the trigeminal nerve, which can severely impair patient’s quality of life. It is primarily caused by vascular compression of the trigeminal nerve root, but it is sometimes secondary to other identifiable neurological conditions, such as multiple sclerosis or a cerebellopontine angle tumor. Uncommonly, it may be caused by the presence of idiopathic intracranial hypertension, a condition most likely identified by headache, visual disturbances, and sixth nerve palsy, among other manifestations. Secondary causes of trigeminal neuralgia are usually detected after an atypical clinical manifestation, such as ophthalmic rather than maxillary or mandibular nerve involvement, more than one branch affected, or bilateral symptoms. We present a patient who presented with trigeminal neuralgia as a primary manifestation, and after thorough evaluation she was diagnosed with intracranial hypertension as the underlying mechanism responsible of the trigeminal neuralgia.

Calcaneus as a Rare Location of Solitary Osteochondromas: Two Case Reports.

Osteochondromas are the most common benign bone tumors, with an incidence of 36% to 41% among benign bone tumors. They can be caused by genetics, trauma, and growth defects. The incidence of all osteochondromas in the hands and feet is approximately 10%, and they are extremely rare in the calcaneus. They generally arise from the metaphysis and metaphyseal-diaphyseal region of the long bones. Osteochondromas, which are generally painless, are noted with signs of inflammation in the bursa, vascular and nerve compression, pain caused by joint deterioration, swelling in the subcutaneous tissue, or gait disturbance. The incidence of malignant transformation of solitary osteochondromas is 1%. We present two cases, an 11-year-old male patient and a 32-year-old male patient, diagnosed with osteochondroma in the calcaneus.

International Union of Angiology consensus document on vascular compression syndromes.

Vascular compression syndromes (VCS) are rare diseases, but they may cause significant symptoms interfering with the quality of life (QoL) of patients who are often in their younger age. Given their infrequent occurrence, multiform clinical and anatomical presentation, and absence of dedicated guidelines from scientific societies, further knowledge of these conditions is required to investigate and treat them using modern imaging and surgical (open or endovascular) techniques. This consensus document will focus on known VCS, affecting the arterial and venous system. The position paper, written by members of International Union of Angiology (IUA) Youth Committee and senior experts, will show an overview of pathophysiology, diagnostic, and therapeutical approaches for patients with VCS. Furthermore, this document will provide also unresolved issues that require more research that need to be addressed in the future.

Median Arcuate Ligament Syndrome: A Case Report

Median Arcuate Ligament Syndrome (MALS) is a rare vascular compression disorder of the celiac artery with non-specific symptomatology that can mimic other, common abdominal diseases. We present one such case of MALS and review the relevant literature on this rare topic.

Vascular Compression of Medulla Oblongata by Non-Dolichoectatic Vertebral Artery

AbstractNeurovascular conflicts are common in the posterior fossa and basal cisterns due to coexistence of important neural and vascular structures. Neurovascular conflict arising from compression of the cranial nerves by pulsatile flow in the adjacent atherosclerotic arteries is well known and is associated with conditions like trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. The medulla is known to be affected by dilated tortuous (dolichoectatic) vertebrobasilar arteries in the elderly or hypertensive. The vertebral artery causing the compression can be dolichoectatic or normal dominant vertebral artery or an elongated tortuous artery. Very few cases of medullary compression by non-dolichoectatic elongated tortuous or dominant vertebral artery were reported in the literature. In this article, we report three cases of medullary compression by the dominant and angulated vertebral artery. Magnetic resonance (MR) imaging with MR angiography showed indentation of the anterolateral aspect of the inferior medulla by the vertebral artery. The patients are managed conservatively and on regular follow-up.

Cystic lymphangioma of the neck in adults: A report of four cases

Background: Cystic lymphangioma is a rare malformation characterized by a cystic structure deriving from detachment of lymph sacs from venous drainage systems. It is the result of the dilatation of capillary and sinusoidal lymphatic vessels still connected to the lymphatic network. Case presentation: In the following article, we describe the clinical and pathological features of cystic lymphangioma of the neck in four adults who underwent a surgical removal of the tumor with a well postoperative progress. Discussion and conclusion: Contrarily to children, the diagnosis of cystic lymphangioma in adults is exceptional. Patients with cystic lymphangioma of the neck are often asymptomatic; However, the lesion growth may cause respiratory disorders, dysphagia, or vascular and neurological compression syndromes. There are multiple modalities of treatment however the surgical complete removal remain the treatment of choice.

Microstructural Alteration of Trigeminal Nerve in Patients with Classic Trigeminal Neuralgia Shown by Diffusion Tensor Imaging and Its Correlation with Vascular Compression and Pain

To investigate the value of MR diffusion tensor imaging (DTI) in evaluating the microstructural alteration of trigeminal nerve in patients with classical trigeminal neuralgia (CTN) and its correlation with the degree of vascular compression and patient pain. A total of 108 patients with CTN were enrolled in this study. Patients were divided into 2 groups according to whether the asymptomatic side trigeminal nerve had neurovascular compression (NVC) or not: group A（32 cases）with NVC and group B（76 cases）without NVC. The anisotropy fraction (FA) and apparent diffusion coefficient (ADC) of bilateral trigeminal nerves were measured. Visual analogue scale (VAS) was used to evaluate the pain degree of the patients. The severity of NVC on the symptomatic side was classified as grade I, II and III by neurosurgeons according to the findings during microvascular decompression (MVD). The FA values of the trigeminal nerve on the symptomatic side were significantly lower than that on the asymptomatic side in group A ( P < 0.001) and group B (P < 0.001). 36 patients were treated with MVD, the FA values of the trigeminal nerve were grade I: 0.309 ± 0.011, grade II: 0.295 ± 0.015, grade III: 0.286±0.022, respectively, the difference was statistically significant ( P=0.011). The FA of the trigeminal nerve on the symptomatic side was negatively correlated with the degree of NVC and pain ( P < 0.05). Patients with NVC had significant decreases in FA and its negatively correlated with NVC and VAS scores.

Trigeminal neuralgia secondary to vascular compression and neurocysticercosis: illustrative case.

Trigeminal neuralgia (TN) is a frequent neurosurgical problem negatively influencing the quality of life of patients. The standard surgical treatment is microvascular decompression for primary cases and decompression of the mass effect, mainly tumors, for secondary cases. Neurocysticercosis (NCC) in the cerebellopontine angle is a rare etiology of TN. The authors report a case in which NCC cysts around the trigeminal nerve coexisted with a vascular loop, which compressed the exit of the trigeminal nerve from the pons. A 78-year-old woman presented with a 3-year history of persistent severe pain in the left side of her face, refractory to medical treatment. On gadolinium-enhanced magnetic resonance imaging, cystic lesions were observed around the left trigeminal nerve and a vascular loop was also present and in contact with the nerve. A retrosigmoid approach for cyst excision plus microvascular decompression of the trigeminal nerve was successfully performed. There were no complications. The patient was discharged without facial pain. Albeit rare, TN secondary to NCC cysts should be considered in the differential diagnosis in NCC-endemic regions. In this case, the cause of the neuralgia was probably both problems, because when both were treated, the patient improved.

Congenital and acquired anomalies of the basilar artery: A pictorial essay.

The basilar artery is one of the two cases in our body where an arterial vessel is formed by the union of two others - the vertebral arteries. It provides vascular supply to essential structures for the main vital functions; the posterior cerebral arteries originate from it as terminal branches, and form part of the anastomotic circle of Willis. Congenital and acquired anomalies of the basilar trunk are described. We provide a schematic and detailed representation of normal anatomical variants - mainly represented by the fenestrated basilar artery or the persistence of carotid-basilar anastomosis; course anomalies are also illustrated, with reference to neuro-vascular conflicts and dolichoectasia. Among congenital anomalies, this pictorial review also shows the variants of the basilar origin, such as in the case of basilar trunk arising from only one of the two vertebral arteries, and the calibre changes - which are represented by aneurysm and hypoplasia. The latter appears to be a risk factor for posterior circulation stroke, when associated with a bilateral posterior foetal variant.Among the acquired forms, this pictorial essay describes some clinical cases of dissections, non-congenital aneurysms, thrombosis and tumour with vascular encasing or compression of basilar artery. CT angiography and MRI allow us to study the posterior intracranial circulation in detail, providing useful pre-treatment information. Therefore, knowledge of congenital or acquired anomalies of the basilar artery is essential for radiologists, neuroradiologists and neurosurgeons.

Pain Outcomes Following Endoscopic Microvascular Decompression for Trigeminal Neuralgia Based on Vascular Compression Type.

Background Arterial compression of the trigeminal nerve at the root entry zone has been the long-attributed cause of compressive trigeminal neuralgia despite numerous studies reporting distal and/or venous compression. The impact of compression type on patient outcomes has not been fully elucidated. Objective We categorized vascular compression (VC) based on vessel and location of compression to correlate pain outcomes based on compression type. Methods A retrospective video review of 217 patients undergoing endoscopic microvascular decompression for trigeminal neuralgia categorizing VC into five distinct types, proximal arterial compression (VC1), proximal venous compression (VC2), distal arterial compression (VC3), distal venous compression (VC4), and no VC (VC5). VC type was correlated with postoperative pain outcomes at 1 month ( n = 179) and last follow-up (mean = 42.9 mo, n = 134). Results At 1 month and longest follow-up, respectively, pain was rated as "much improved" or "very much improved" in 89 69% of patients with VC1, 86.6 and 62.5% of patients with VC2, 100 and 87.5% of patients with VC3, 83 and 62.5% of patients with VC4, and 100 and 100% of patients with VC5. Multivariate analysis demonstrated VC4 as a significant negative of predictor pain outcomes at 1 month, but not longest follow-up, and advanced age as a significant positive predictor. Conclusion The degree of clinical improvement in all types of VC was excellent, but at longest follow-up VC type was not a significant predictor out outcome. However distal venous compression was significantly associated with worse outcomes at 1 month.

The Role of Magnetic Resonance Imaging in the evaluation of Trigeminal Neuralgia: a pilot study

Introduction Trigeminal neuralgia is a debilitating painful condition affecting one or more branches of trigeminal nerve characterized by sharp shooting, electric shock like pain lasting for a short time. In most cases, no specific cause can be identified but certain do tend to occur due to lesions or damage to the trigeminal nerve due to vascular compression, tumors, etc. which can be detected by magnetic resonance imaging. Hence, this pilot study was conducted to identify any underlying causes for trigeminal neuralgia using magnetic resonance imaging. Methods A prospective cross-sectional descriptive study was conducted on 10 patients who were presented to department with clinical symptoms of trigeminal neuralgia. Magnetic resonance imaging of the brain with trigeminal protocol was conducted. The evaluation of the entire course of the trigeminal nerve was then performed by an experienced radiologist. Results Out of the 10 patients, 6 were females and 4 males. Four patients did not show presence of any pathology i.e. were idiopathic. Five cases reported with neurovascular compression and one showed the presence of a tumor at the cerebellopontine angle compressing the nerve. Conclusion In this study, with use of magnetic resonance imaging, a 60% occurrence of an underlying pathology was demonstrated which could be treated to relieve the neuralgia. Hence, taking into account the high prevalence of etiological factors which could contribute towards trigeminal neuralgia detected on MRI, large scale studies can be considered for the same.