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Concept: Trigeminal ganglion


Modern crocodylians possess a derived sense of face touch, in which numerous trigeminal nerve-innervated dome pressure receptors speckle the face and mandible and sense mechanical stimuli. However, the morphological features of this system are not well known, and it remains unclear how the trigeminal system changes during ontogeny and how it scales with other cranial structures. Finally, when this system evolved within crocodyliforms remains a mystery. Thus, new morphological insights into the trigeminal system of extant crocodylians may offer new paleontological tools to investigate this evolutionary transformation. A cross-sectional study integrating histological, morphometric, and 3D imaging analyses was conducted to identify patterns in cranial nervous and bony structures of Alligator mississippiensis. Nine individuals from a broad size range were CT-scanned followed by histomorphometric sampling of mandibular and maxillary nerve divisions of the trigeminal nerve. Endocast volume, trigeminal fossa volume, and maxillomandibular foramen size were compared with axon counts from proximal and distal regions of the trigeminal nerves to identify scaling properties of the structures. The trigeminal fossa has a significant positive correlation with skull length and endocast volume. We also found that axon density is greater in smaller alligators and total axon count has a significant negative correlation with skull size. Six additional extant and fossil crocodyliforms were included in a supplementary scaling analysis, which found that size was not an accurate predictor of trigeminal anatomy. This suggests that phylogeny or somatosensory adaptations may be responsible for the variation in trigeminal ganglion and nerve size in crocodyliforms. Anat Rec, 00:000-000, 2013. © 2013 Wiley Periodicals, Inc.

Concepts: Nervous system, Neuroanatomy, Cranial nerves, Mandibular nerve, Trigeminal nerve, Maxillary nerve, Trigeminal ganglion, Alligator


The aim of this study was to evaluate the therapeutic effect of computed tomography (CT)-guided percutaneous ozone injection for refractory trigeminal neuralgia.

Concepts: Nervous system, Therapeutic effect, Tomographic reconstruction, Internal carotid artery, Mandibular nerve, Trigeminal nerve, Trigeminal neuralgia, Trigeminal ganglion


Several techniques have been described for the percutaneous treatment of trigeminal neuralgia; however, each has significant drawbacks. We propose a new technique for percutaneous balloon compression of the trigeminal ganglion and distal trigeminal nerve using electromagnetic (EM) neuronavigation.

Concepts: Nervous system, Neuroanatomy, Creativity techniques, Cranial nerves, Mandibular nerve, Trigeminal nerve, Trigeminal neuralgia, Trigeminal ganglion


Meckel’s cave is a dural recess in the posteromedial portion of the middle cranial fossa that acts as a conduit for the trigeminal nerve between the prepontine cistern and the cavernous sinus, and houses the Gasserian ganglion and proximal rootlets of the trigeminal nerve. It serves as a major pathway in perineural spread of pathologies such as head and neck neoplasms, automatically upstaging tumours, and is a key structure to assess in cases of trigeminal neuralgia. The purpose of this pictorial review is threefold: (1) to review the normal anatomy of Meckel’s cave; (2) to describe imaging findings that identify disease involving Meckel’s cave; (3) to present case examples of trigeminal and non-trigeminal processes affecting Meckel’s cave.

Concepts: Cancer, Internal carotid artery, Cranial nerves, Mandibular nerve, Trigeminal nerve, Trigeminal neuralgia, Trigeminal ganglion


This study assessed the ability of endothelin-1 (ET-1) to evoke heat hyperalgesia when injected directly into the trigeminal ganglia (TG) of mice and determined the receptors implicated in this effect. The effects of TG ETAand ETBreceptor blockade on alleviation of heat hyperalgesia in a model of trigeminal neuropathic pain induced by infraorbital nerve constriction (CION) were also examined.

Concepts: Nervous system, Ganglion, Effect, Pain, Cranial nerves, Mandibular nerve, Trigeminal nerve, Trigeminal ganglion


We describe a new and freely available 3D interactive model of the intracranial internal carotid artery (ICA) and the skull base that also allows to display and compare its main segment classifications. High-resolution 3D human angiography (isometric voxel’s size 0.36 mm) and Computed Tomography angiography images were exported to Virtual Reality Modeling Language (VRML) format for processing in a 3D software platform and embedding in a 3D Portable Document Format (PDF) document that can be freely downloaded at and runs under Acrobat Reader on Mac and Windows computers and Windows 10 tablets. The 3D-PDF allows for visualisation and interaction through JavaScript-based functions (including zoom, rotation, selective visualization and transparentation of structures or a predefined sequence view of the main segment classifications if desired). The ICA and its main branches and loops, the Gasserian ganglion, the petrolingual ligament and the proximal and distal dural rings within the skull base environment (anterior and posterior clinoid processes, silla turcica, ethmoid and sphenoid bones, orbital fossae) may be visualized from different perspectives. This interactive 3D-PDF provides virtual views of the ICA and becomes an innovative tool to improve the understanding of the neuroanatomy of the ICA and surrounding structures.

Concepts: Skull, Internal carotid artery, Common carotid artery, Computer graphics, Virtual reality, 3D computer graphics, Trigeminal ganglion, VRML


OBJECTIVE Treatment of hemorrhagic cavernous malformations within the lateral pontine region demands meticulous surgical planning and execution to maximize resection while minimizing morbidity. The authors report a single institution’s experience using the extended middle fossa rhomboid approach for the safe resection of hemorrhagic cavernomas involving the lateral pons. METHODS A retrospective chart review was performed to identify and review the surgical outcomes of patients who underwent an extended middle fossa rhomboid approach for the resection of hemorrhagic cavernomas involving the lateral pons during a 10-year period at Rady Children’s Hospital of San Diego. Surgical landmarks for this extradural approach were based on the Fukushima dual-fan model, which defines the rhomboid based on the following anatomical structures: 1) the junction of the greater superficial petrosal nerve (GSPN) and mandibular branch of the trigeminal nerve; 2) the lateral edge of the porus trigeminus; 3) the intersection of the petrous ridge and arcuate eminence; and 4) the intersection of the GSPN, geniculate ganglion, and arcuate eminence. The boundaries of maximal bony removal for this approach are the clivus inferiorly below the inferior petrosal sinus; unroofing of the internal auditory canal posteriorly; skeletonizing the geniculate ganglion, GSPN, and internal carotid artery laterally; and drilling under the Gasserian ganglion anteriorly. This extradural petrosectomy allowed for an approach to all lesions from an area posterolateral to the basilar artery near its junction with cranial nerve (CN) VI, superior to the anterior inferior cerebellar artery and lateral to the origin of CN V. Retraction of the mandibular branch of the trigeminal nerve during this approach allowed avoidance of the region involving CN IV and the superior cerebellar artery. RESULTS Eight pediatric patients (4 girls and 4 boys, mean age of 13.2 ± 4.6 years) with hemorrhagic cavernomas involving the lateral pons and extension to the pial surface were treated using the surgical approach described above. Seven cavernomas were completely resected. In the eighth patient, a second peripheral lesion was not resected with the primary lesion. One patient had a transient CN VI palsy, and 2 patients had transient trigeminal hypesthesia/dysesthesia. One patient experienced a CSF leak that was successfully treated by oversewing the wound. CONCLUSIONS The extended middle fossa approach can be used for resection of lateral pontine hemorrhagic cavernomas with minimal morbidity in the pediatric population.

Concepts: Cerebellum, Cranial nerves, Anterior inferior cerebellar artery, Mandibular nerve, Cavernous sinus, Trigeminal nerve, Trigeminal ganglion, Pons


Orofacial neuropathic pain caused by trigeminal nerve injury is a debilitating condition with limited therapeutic options. Hyperpolarization-activated cyclic nucleotide-gated (HCN) channels regulate neuronal excitability and are involved in the development and maintenance of chronic pain. However, the impact of HCN channel activity in the gasserian ganglion on trigeminal neuropathic pain has not been examined. We evaluated nociceptive behaviors after microinjection of the HCN channel blockers ZD7288 or ivabradine into the gasserian ganglion in rats with trigeminal nerve injury. Both blockers dose-dependently ameliorated evoked and spontaneous nociceptive behavior in rats with trigeminal neuropathic pain. Moreover, clinically available HCN channel blocker ivabradine showed a prolonged anti-nociceptive effect. In the gasserian ganglion, HCN1 and HCN2 are major HCN isoforms. After trigeminal nerve injury, the counts of both HCN1 and HCN2 immuno-positive punctae were increased in the ipsilateral gasserian ganglions. These results indicate that the increased HCN channel activity in the gasserian ganglion directly contributes to neuropathic pain resulting from trigeminal nerve injury.

Concepts: Nervous system, Pain, Cranial nerves, Nociception, Ion channels, Mandibular nerve, Trigeminal nerve, Trigeminal ganglion


Sensitivity to cooling temperatures often becomes heightened in orofacial regions leading to orofacial cold allodynia/hyperalgesia after chronic trigeminal nerve injury. KCNQ2 channels are involved in controlling excitability of primary afferent neurons and thereby regulate sensory functions under both physiological and pathological conditions. In the present study, we sought to determine whether KCNQ2 channels in trigeminal nerves are involved in regulating orofacial operant behavioral responses to cooling stimulation. We also sought to examine whether chronic trigeminal nerve injury may alter KCNQ2 channel expression in trigeminal ganglions. Using the orofacial operant tests, animals show cold allodynia/hyperalgesia in orofacial regions following infraorbital nerve chronic constrictive injury (ION-CCI), which could be alleviated by subcutaneous administration of retigabine, a KCNQ2 activator. In contrast, subcutaneous administration of the KCNQ2 inhibitor XE991 directly elicits cold allodynia/hyperalgesia in sham animals. Using immunostaining, we show that KCNQ2 channels are primarily expressed in small-sized TG neurons. Interestingly, KCNQ2 channel expression becomes significantly upregulated in TG neurons following the ION-CCI. Our results suggest that KCNQ2 channels are involved in regulating orofacial cold sensitivity. Upregulation of KCNQ2 channels may be a compensatory change in attempting to limit injury-induced trigeminal hyperexcitability.

Concepts: Nervous system, Gene expression, Action potential, Cranial nerves, Mandibular nerve, Trigeminal nerve, Maxillary nerve, Trigeminal ganglion


The authors introduce a new method to build a three-dimensional (3D) model of the 3 branches of the trigeminal nerve in the trigeminal ganglion of rabbit with 3 different kinds of fluorescence. Ten adult New Zealand rabbits of both sexes weighing between 2.0 and 3.0 kg were used in the experiment. Then through an operation under general anesthesia, the maxillary and mandibular nerves were exposed, and red and gold fluorescence were applied to investigate the neurons of the maxillary and mandibular nerves. Subsequently, DiI was used as a marker for the ophthalmic neuron for the other side of the same rabbit. After receiving images of the 3 branches under a fluorescence microscope, a 3D model of the 3 branches of the trigeminal nerve could be built. The authors obtained an image of the 3 branches of neurons in the trigeminal ganglion, and a 3D model of the 3 branches of the trigeminal nerve in the trigeminal ganglion was reconstructed. In the trigeminal ganglion, ophthalmic neurons were concentrated in the anteromedial section, the maxillary division in the middle, and the mandibular division posterolaterally. Overlap was observed between the ophthalmic and maxillary neurons, and also for the maxillary and mandible neurons.

Concepts: Nervous system, Axon, Cranial nerves, Mandibular nerve, Trigeminal nerve, Maxillary nerve, Lingual nerve, Trigeminal ganglion