• Amit Kumar, Yuichi Kubota, Suguru Yokosako, and Mikhail Chernov.
• Department of Neurosciences, Bhagwan Mahavir MEDICA Superspecialty Hospital, Ranchi, Jharkhand, India, and Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan.
• World Neurosurg. 2024 Nov 22.

ObjectiveTo assess radiological characteristics, which may support the clinical diagnosis of trigeminal neuralgia (TN) caused by pure venous conflict.MethodsPreoperative constructive interference in steady state (CISS) images were analyzed retrospectively in 30 patients with TN caused by pure venous conflict, which was confirmed during microvascular decompression (MVD) surgery. Length, width, T2 hyperintensity, and shape of the cisternal segment of trigeminal nerve (CN V), as well as sizes of the trigeminal-pontine angle, trigeminal-petrous angle, and cerebellopontine cistern were evaluated on both sides.ResultsOn the affected side, the length of CN V was significantly shorter (mean, 7.9 vs. 9.0 mm; P = 0.0249), whereas its width in mid-portion (mean, 4.0 vs. 3.5 mm; P = 0.0022) and the size of trigeminal-pontine angle (mean, 55.3 vs. 48.8 degrees; P = 0.0052) were significantly larger. Other evaluated characteristics did not differ significantly between affected and non-affected sides. Statistically significant odds ratios (OR) for the association with affected side were revealed for shorter length (OR, 10.5; P = 0.0319) and larger width (OR, 8.8; P = 0.0487) of CN V; the presence of either of these parameters (i.e., "shorter and/or thicker CN V") provided the highest discriminative value (OR, 19.3; P = 0.0063).ConclusionIdentification of shorter and/or thicker CN V on the affected side in patients with TN without obvious offending vessel on MRI may suggest presence of pure venous conflict and help with decision-making on MVD surgery.Copyright © 2024. Published by Elsevier Inc.

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