Anatomical study of the trigeminal and facial cranial nerves with the aid of 3.0-tesla magnetic resonance imaging.
OBJECTIVE
Neuroimages often reveal that the trigeminal or facial nerve comes in contact with vessels but does not produce symptoms of trigeminal neuralgia (TN) or hemifacial spasm (HFS). The authors conducted this study to determine how often the trigeminal and facial nerves came in contact with vessels in individuals not suffering from TN or HFS. They also investigated the correlation between aging and the anatomical measurements of the trigeminal and facial nerves.


METHODS
Between November 2005 and August 2006, 220 nerves in 110 individuals (60 women and 50 men; mean age 55.1 years, range 19-85 years) who had undergone brain magnetic resonance (MR) imaging for other reasons were studied. The lengths, angles, ratio, and contact points were measured in each individual. A correlation between each parameter and age was statistically analyzed.


RESULTS
The mean (+/- standard deviation) length of the trigeminal nerve was 9.66 +/- 1.71 mm, the mean distance between the bilateral trigeminal nerves was 31.97 +/- 1.82 mm, and the mean angle between the trigeminal nerve and the midline was 9.71 +/- 5.83 degrees . The trigeminal nerve was significantly longer in older patients. Of 220 trigeminal nerves, 108 (49.0%; 51 women and 57 men) came in contact with vasculature. There was 1 contact point in 99 nerves (45%) and 2 contact points in 9 nerves (4.1%). Contact without deviation of the nerve was seen in 91 individuals (43 women and 48 men), and mild deviation was noted in 17 individuals (8 women and 9 men). There was no moderate or severe deviation in any individual in this series. The mean length of the facial nerve was 29.78 +/- 2.31 mm, the mean distance between the bilateral facial nerves was 28.65 +/- 2.22 mm, the angle between the nerve and midline was 69.68 +/- 5.84 degrees , and the vertical ratio at the porus acusticus was 0.467 +/- 0.169. Of all facial nerves, 173 (78.6%; 101 in women and 72 in men) came in contact with some vasculature. Contact without deviation was seen on 64 sides (in 37 women and 27 men), mild deviation on 98 sides (in 57 women and 41 men), and moderate deviation on 11 sides (in 7 women and 4 men). There was no severe deviation of the facial nerve in this series. The proximal length of the facial nerve, interval, angle, and ratio against the age were significantly shorter or smaller in the older individuals.


CONCLUSIONS
The findings in asymptomatic individuals in this study will help in deciding which findings observed on MR images may cause symptoms. In addition, the authors describe the variations of normal anatomy in older individuals. Knowledge of the normal anatomy helps to hone the diagnostic practices for microvascular decompression, which may increase the feasible results on such surgery.
Kakizawa
Yukinari
Y
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan. kakizawa@hsp.md.shinshu-u.ac.jp
Seguchi
Tatsuya
T
Kodama
Kunihiko
K
Ogiwara
Toshihiro
T
Sasaki
Tetsuo
T
Goto
Tetsuya
T
Hongo
Kazuhiro
K
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001837:Body Weights and Measures; D005154:Facial Nerve / Q000033:anatomy & histology*; D005260:Female; D019569:Hemifacial Spasm / Q000209:etiology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012737:Sex Factors; D014276:Trigeminal Nerve / Q000033:anatomy & histology*; D014277:Trigeminal Neuralgia / Q000209:etiology / Q000601:surgery