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Neurovascular relationship at the trigeminal root entry zone in persistent idiopathic facial pain: findings from MRI 3D visualisation


Background: Patients with atypical neuralgia or atypical facial pain have been surgically treated with microvascular decompression (MVD) of the trigeminal root entry zone (TREZ). There are no data regarding the sensitivity and specificity of a vessel–TREZ relationship as a cause of pain in patients with persistent idiopathic facial pain (PIFP) according to the definition given by the International Headache Society (IHS).

Methods: The TREZ was visualised by 3D CISS MRI in 12 patients with unilateral PIFP according to the IHS criteria.

Results: The frequency of artery–TREZ, vein–TREZ, or vessel (artery/vein)–TREZ contacts on the symptomatic and asymptomatic sides did not differ significantly. On the symptomatic side, vessel–TREZ contact was found in 58% of patients (sensitivity). On the asymptomatic side, vessel–TREZ contact was absent in 33% of patients (specificity).

Conclusions: On the basis of the low sensitivity and specificity found in the present study, PIFP cannot be attributed to a vessel–TREZ contact, and therefore, pain relief after MVD cannot be expected.

  • CISS, constructive interference in steady state
  • IHS, International Headache Society
  • MVD, microvascular decompression
  • PIFP, persistent idiopathic facial pain
  • TREZ, trigeminal root entry zone
  • persistent idiopathic facial pain
  • atypical facial pain
  • trigeminal root entry zone
  • vessel–nerve contact
  • MRI 3D visualisation

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