13 December 2021>: Articles
Use of High-Resolution Magnetic Resonance Imaging (MRI) for Radiological Diagnosis of Neurovascular Conflict: A Case Report
Challenging differential diagnosis, Diagnostic / therapeutic accidents, Rare diseaseArturs Balodis A* , Raimonds Mikijanskis B , Linda Helēna Saulkalne B , Ramona Valante D
Am J Case Rep 2021; 22:e933566
Figure 1. Patient A. (A) Initial head magnetic resonance imaging (MRI) without contrast (Philips Ingenia 1.5 T): T2-weighted, sampling perfection with application optimized contrasts, isotropic. No findings suggest significant deformation of the roots of the trigeminal nerve. The vascular structures are attached to the left root of the nerve and most likely are veins after passage. There is no convincing direct contact with arterial vessels. (B) A repeat head MRI scan (Philips Ingenia 1.5 T) showing the multiplanar reconstruction of the nerves in the coronal plane. A reasonably close passing vessel is visible in the proximal part of the left trigeminal nerve, which most likely is the left inferior cerebellar artery. According to diagnostic criteria for neurovascular conflict (NVC), the vessel must cross the nerve perpendicularly and there must be deformations and angulations in the nerve’s course (“bending”). (C) An intraoperative image from Dr. R. Mikijanskis’s archives. An NVC of the left anterior cerebellar artery is seen from behind and with the petrosa vein in the front. (D) An intraoperative image from Dr. R. Mikijanskis’s archives. The Teflon material between the nerve and the artery ensures that they are not in contact. A similar separation can be done between a nerve and a vein.