High-resolution MRI affords exquisite anatomic detail and allows radiologists to scrutinize the entire course of the trigeminal nerve (cranial nerve [CN] V). This article focuses first on the normal MRI appearance of the course of CN V and how best to image each segment. Special attention is then devoted to the role of MRI in presurgical evaluation of patients with neurovascular conflict and in identifying secondary causes of trigeminal neuralgia, including multiple sclerosis. Fundamental concepts in postsurgical imaging after neurovascular decompression are also addressed. Finally, how imaging has been used to better understand the etiology of trigeminal neuralgia is discussed.
Key points
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High-resolution isotropic imaging allows detailed evaluation of nearly the entire course of the trigeminal nerve (cranial nerve [CN] V), from its brainstem nuclei to the distal branches of its 3 main divisions.
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Imaging in patients with trigeminal neuralgia (TGN) allows assessment for the presence, type, and degree of neurovascular contact in the cerebellopontine cistern.
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Imaging also allows evaluation for secondary causes of TGN, including multiple sclerosis (MS) as well as benign and malignant neoplasms.
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State-of-the-art MRI techniques, including diffusion tensor imaging (DTI) and functional MRI (fMRI), are providing insight into the pathogenesis of TGN.
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