Retrospective Analysis of Brain MRI Findings in Patients with Clinical Diagnosis of Trigeminal Neuralgia in Tikur Anbessa Specialized Hospital and MyungSung Christian Medical Center
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Date
2025
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Addis Ababa University
Abstract
Background: Trigeminal neuralgia (TN) is a debilitating facial pain disorder most commonly caused by neurovascular compression (NVC) of the trigeminal nerve, as well as secondary and idiopathic causes. Magnetic resonance imaging (MRI) plays a central role in identifying etiologies and guiding management, particularly in distinguishing clinically relevant neurovascular conflict from incidental contact.
Objective: To describe MRI patterns in patients with clinically diagnosed trigeminal neuralgia and to compare neurovascular relationships between symptomatic and asymptomatic side.
Methods: A retrospective multicenter cross-sectional study was conducted at Tikur Anbessa Specialized Hospital (TASH) and Myung Sung Christian Medical Center (MCM), Ethiopia, including patients aged ≥18 years with a clinical diagnosis of TN who underwent MRI between January 2024 and December 2025. MRI scans were reviewed for neurovascular contact or conflict, secondary structural causes, and incidental findings. Paired comparisons between symptomatic and asymptomatic sides were performed using Mc Nemar’s test.
Results: Thirty-four patients were included (mean age 53.2 ± 17.7 years), with equal gender distribution. Trigeminal neuralgia was predominantly unilateral (97.1%), more frequently affecting the right side (60.6%). Neurovascular compression was identified in 25 patients (73.5%), constituting the most common etiology. Secondary causes were found in 5 patients (14.7%), including multiple sclerosis and tumors, while 4 patients (11.8%) had normal MRI findings consistent with idiopathic TN. Neurovascular contact or conflict was significantly more frequent on the symptomatic side compared with the asymptomatic side (p < 0.001), and true neurovascular conflict was strongly associated with symptoms (p = 0.012). The superior cerebellar artery was the most commonly implicated vessel 21 (84%). Most patients were managed medically, while microvascular decompression was performed in 6 patients (17.6%) with MRI-confirmed NVC.
Conclusion: MRI is a valuable tool in evaluating trigeminal neuralgia, demonstrating a high prevalence of neurovascular compression, particularly on the symptomatic side. Differentiating neurovascular conflict from simple contact is essential for etiological classification and surgical decision-making. Routine use of standardized high-resolution MRI protocols is recommended to optimize diagnosis and management of trigeminal neuralgia, especially in resource-limited settings.
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Keywords
Magnetic resonance imaging, Trigeminal Neuralgia, Trigeminal Neuralgia Classification. Neurovascular Contact, Neurovascular Conflict