Skip to main content
  • High Resolution MRI Findings Following Trigeminal Rhizotomy

    Final Number:

    C. Rory Goodwin MD PhD; Benjamin Northcutt; Daniel Seeburg; Jaehoon Shin; Debebe Theodros BS; Nancy A Abu-Bonsrah BS; Daniel Herzka; Nafi Aygun; Ari M Blitz MD; Michael Lim MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Patients with trigeminal neuralgia often undergo glycerol or radiofrequency radiofrequency-thermocoagulation glycerol rhizotomy of the trigeminal nerve for treatment of symptoms. To date radiologic changes in patients with trigeminal neuralgia post rhizotomy have not been described. The aim of this study was to evaluate patients after trigeminal rhizotomy to characterize post-rhizotomy changes on 3D high resolution MRI.

    Methods: A retrospective review of trigeminal neuralgia protocol studies was peformed on 26 post-rhizotomy patients compared with 54 treatment naïve trigeminal neuralgia subjects. Examinations were reviewed independantly by two neuroradiologists blinded to side of symptoms and treatment history. Symmetry of Meckel’s caves on constructive interference in steady state (CISS) and the presence of contrast enhancement within the trigeminal nerves on volumetric interpolated breath-hold examination (VIBE) images was assessed subjectively. Signal intensity (SI) of Meckel’s cave was measured on coronal non-contrast CISS imaging on each side.

    Results: Post rhizotomy changes include subjective clumping of nerve roots and/or decreased CISS SI within Meckel’s cave, which was identified in 17/26 (65%) patients after rhizotomy and 3/54 (6%) treatment naïve patients (p<0.0001). CISS SI within Meckel’s cave was on average 13% lower on the side of rhizotomy in post treatment patients, compared to 1% difference in controls (p<0.0001). Small regions of temporal encephalomalacia were noted in 8/26 cases (31%) of patient post rhizotomy and 0/54 (0%) of treatment naïve patients (p<0.0001).

    Conclusions: Post trigeminal rhizotomy findings frequently include nerve clumping and decreased CISS signal in Meckel’s cave. Small areas of temporal encephalomalacia are encountered less frequently.

    Patient Care: Understanding radiologic changes that occur after rhizotomy will allow for the delineation of how these changes are related to the extent and durability of pain relief following rhizotomy

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe radiologic changes in patients with trigeminal neuralgia post rhizotomy

    References: 1. Prasad S, Galetta S. Trigeminal Neuralgia: Historical Notes and Current Concepts. Neurologist 2009;15:87–94 2. Penman J. Trigeminal neuralgia. In: Handbook of Clinical neurology. Vinken PJ, Bruyn GW (eds.). Amsterdam, North Holland, 1968, vol. 5 : 296-322. 3. Katusic S, Beard M, Bergstralh E, Kurland LT. Incidence and Clinical Features of Trigeminal Neuralgia, Rochester, Minnesota, 1945–1984. Ann Neurol 1990;27:89–95 4. Rozen TD. Trigeminal Neuralgia and Glossopharyngeal Neuralgia. Neurol Clin North Amer 2004.22:185–206 5. Manzoni GC, Torelli P. Epidemiology of Typical and Atypical Craniofacial Neuralgias. Neurol Sci 2005;26(suppl 2):s65–s67. 6. Campbell FG, Graham JG, Zilkha KJ. Clinical Trial of Carbazepine (Tegretol) in Trigeminal Neuralgia. J Neurol Neurosurg Psychiatry 1966;29: 265–267 7. Tatli M, Satici O, Kanpolat Y, Sindou M. Various Surgical Modalities for Trigeminal Neuralgia: Literature Study of Respective Long-Term Outcomes. Acta Neurochirurgica 2008; 150(3): 243-255. 8. Barker FG II, Jannetta PJ, Bisonette, et al. The Long-Term Outcome of Microvascular Decompression for Trigeminal Neuralgia. N Engl J Med 1996; 334:1077–1083. 9. MIssios S, Mohammadi A, Barnett G. Percutaneous Treatments for Trigeminal Neuralgia. Neurosurgery Clinics of North America 25 (2014) 751-762. 10. Tew JM, Morgan CJ, Grande AW. Percutaneous Stereotactic Rhizotomy in Treatment of Intractable Facial Pain. In: Schmidek and Sweet's Operative Neurosurgical Techniques, Sixth Edition. Quinones-Hinojosa A, (ed.) Philadelphia, PA: Elsevier Saunders Co; 2012:

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy