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Anatomy or the Trigeminal Nerve. Key Anatomical Facts for MRI Examination of Trigeminal Neuralgia
2a 2b
mastication muscles, and is correspondingly the temporal bone, where it finds Meckel´s
called mastication nucleus. space region. During this course,
The fibers related with all these nuclei surrounded by cerebrospinal fluid, it
gather in the pons and emerge through the presents distant relations with cranial
lateral sector of its anterior aspect, forming nerves VI, VII and VIII, and vascular
a thick nervous tract with two roots: a relations, with the superior petrous vein
thicker and lateral sensitive root and a (Dandy), and more especially arterial
thinner more medial motor root. relations. Figures 2 and 4
The only intra-axial segment of the Vth ends This is the point where the variants in the
there and initiates its long course to its trajectories and the resulting arterial loops,
distribution territory; it is formed by may generate sites of close contact
different sub-segments before dividing between the arterial, pulsating vessels and
itself into its terminal branches (the the nervous tract which may result in
cisternal and Gasserian or transdural neurovascular conflict.
segments). Figure 2 Two arteries may be related: the middle
The point where the roots emerge in the and the superior cerebellar arteries,
brainstem is called “REZ” (Root Entry Zone), according to the height of its origin in the
an anatomical landmark of great functional basilar trunk and the direction of its initial
hierarchy. Figure 3 portion. Figure 5
3a 3b
The cisternal (Vc) or pre-ganglionar It later enters Meckel´s space, the region
segment occupies the upper floor sector of where the Gasserian ganglion is located, a
the cerebellopontine angle, above the ganglionar station relaying sensitive
acoustic-vestibulo-facial bundle, heading information, and following which its three
upwards and laterally, from the posterior terminal branches originate: the ophthalmic
fossa to the apex of the petrous portion of
Anatomy or the Trigeminal Nerve. Key Anatomical Facts for MRI Examination of Trigeminal Neuralgia
(V1), maxillary (V2) and mandibular (V3) Prior to this, the three sensitive branches
nerves. establish a close relationship with the
This region is a space carved in a dural fold, lateral wall of the cavernous sinus, passing
occupied in nearly all specimens by through the width of the duramater,
cerebrospinal fluid. Here the nervous trunk especially V1 and V2.
is formed by multiple small nerve roots and After going through this sector, V1 reaches
the ganglion is formed actually by a true the superior orbital fissure (sphenoidal
network of minute nerve filaments and cleft) and crosses it to reach the orbit
therefore should be called plexus rather where it is distributed.
than ganglion. Only the sensitive fibers form Its distribution territory encompasses the
part of this structure, the small motor tract sensitivity of the eye-globe and conjunctiva,
passes, in the majority of cases, below the eyelids, frontal region, the skin of the nose
ganglion –as may be clearly observed in the and naso-sinusal mucosa, and the
dissections carried out. Figure 6 vegetative innervation of the lacrimal
After the Gasserian ganglion, the glands.
distribution branches, already separated in The second branch, V2, goes towards the
all cases, run forward seeking for the foramen rotundum in the middle fossa of
different orifices in the skull base though the skull, reaching the pterygo-palatine
which they reach their distribution territory. region where it subdivides into multiple
Figure 7 collateral branches.
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4c
5a 5b
The main tract of this branch continues in skull through the foramen ovale, and
the floor of the orbit to emerge in the face reaches the deep masticator space.
through the infraorbital orifice and is There it forms multiple sensitive branches
distributed in the skin of the middle facial destined for the lower third of the face and
territory and part of the oral cavity. part of the oral cavity, additionally to the
Finally V3, which travels together with the temporo-mandibular joint, while the motor
motor root of the nerve, crosses the base of branches supply the mastication muscles.
6a 6b
Anatomy or the Trigeminal Nerve. Key Anatomical Facts for MRI Examination of Trigeminal Neuralgia
7a 7b
7c
could explain the clinical presentation of a portions with great resolution. In the high
relatively frequent syndrome such as the TN resolution sequences the nervous tract and
(6, 7). its portions may be observed in great detail
This may occur, not only with involvement together with the region of Meckel´s space,
of the nervous trunk or its distribution with an excellent correlation with the
branches, but also of its intra-axial portions cadaveric dissections.
or those in the region of Meckel´s space, It is essential to have an accurate
thus, making it necessary to identify them knowledge of the anatomy of the Vth,
correctly (5). together with that of the regions and
Several disorders of different sorts may give spaces it crosses, in order to achieve an
rise to this clinical condition, the majority of adequate anatomic imaging analysis in
which, such as for example tumoral lesions, studies with excellent spatial resolution
may be easily assessed with MRI using such as MRI.
conventional sequences.
In some situations it is fundamental to Bibliography
consider the precise anatomical details and
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TN is a specific entity, with a characteristic 7.- Lang E, Naraghi R, Tanrikulu L et al.
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anatomical relations between the Vth and facial pain: findings from MRI 3-D
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In all the studies analyzed it is possible to 2005; 76:1506-1509
clearly identify the Vth in its different