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The trigeminal nerve at the site of NVC has been extensively studied but limbic structures that are potentially involved in TN have not been adequately characterized. Specifically, the hippocampus is a stress-sensitive region which may be structurally impacted by chronic TN pain. As the center of the emotion-related network, the amygdala is closely related to stress regulation and may be associated with TN pain as well. The thalamus, which is involved in the trigeminal sensory pathway and nociception, may play a role in pain processing of TN. The objective of this study was to assess structural alterations in the trigeminal nerve and subregions of the hippocampus, amygdala, and thalamus in TN patients using ultra-high field MRI and examine quantitative differences in these structures compared with healthy controls.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Thirteen TN patients and 13 matched controls were scanned at 7-Tesla MRI with high resolution, T1-weighted imaging. Nerve cross sectional area (CSA) was measured and an automated algorithm was used to segment hippocampal, amygdaloid, and thalamic subregions. Nerve CSA and limbic structure subnuclei volumes were compared between TN patients and controls.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>CSA of the posterior cisternal nerve on the symptomatic side was smaller in patients (3.75\u2009mm<jats:sup>2<\/jats:sup>) compared with side-matched controls (5.77\u2009mm<jats:sup>2<\/jats:sup>, <jats:italic>p<\/jats:italic>\u00a0=\u20090.006). In TN patients, basal subnucleus amygdala volume (0.347\u2009mm<jats:sup>3<\/jats:sup>) was reduced on the symptomatic side compared with controls (0.401\u2009mm<jats:sup>3<\/jats:sup>, <jats:italic>p<\/jats:italic>\u00a0=\u20090.025) and the paralaminar subnucleus volume (0.04\u2009mm<jats:sup>3<\/jats:sup>) was also reduced on the symptomatic side compared with controls (0.05\u2009mm<jats:sup>3<\/jats:sup>, <jats:italic>p<\/jats:italic>\u00a0=\u20090.009). The central lateral thalamic subnucleus was larger in TN patients on both the symptomatic side (0.033\u2009mm<jats:sup>3<\/jats:sup>) and asymptomatic side (0.035\u2009mm<jats:sup>3<\/jats:sup>), compared with the corresponding sides in controls (0.025\u2009mm<jats:sup>3<\/jats:sup> on both sides, <jats:italic>p<\/jats:italic>\u00a0=\u20090.048 and <jats:italic>p<\/jats:italic>\u00a0=\u20090.003 respectively). The inferior and lateral pulvinar thalamic subnuclei were both reduced in TN patients on the symptomatic side (0.2\u2009mm<jats:sup>3<\/jats:sup> and 0.17\u2009mm<jats:sup>3<\/jats:sup> respectively) compared to controls (0.23\u2009mm<jats:sup>3<\/jats:sup>, <jats:italic>p<\/jats:italic>\u00a0=\u20090.04 and 0.18\u2009mm<jats:sup>3<\/jats:sup>, <jats:italic>p<\/jats:italic>\u00a0=\u20090.04 respectively). No significant findings were found in the hippocampal subfields analyzed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>These findings, generated through a highly sensitive 7\u2009T MRI protocol, provide compelling support for the theory that TN neurobiology is a complex amalgamation of local structural changes within the trigeminal nerve and structural alterations in subnuclei of limbic structures directly and indirectly involved in nociception and pain processing.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s10194-021-01325-4","type":"journal-article","created":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T21:04:21Z","timestamp":1632431061000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Leveraging high-resolution 7-tesla MRI to derive quantitative metrics for the trigeminal nerve and subnuclei of limbic structures in trigeminal neuralgia"],"prefix":"10.1186","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3422-4032","authenticated-orcid":false,"given":"Judy","family":"Alper","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan C.","family":"Seifert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaurav","family":"Verma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuang-Han","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yael","family":"Jacob","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameen","family":"Al Qadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W.","family":"Rutland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheetal","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Bederson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj K.","family":"Shrivastava","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley N.","family":"Delman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priti","family":"Balchandani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,23]]},"reference":[{"key":"1325_CR1","unstructured":"U.S. Department of Health and Human Services (2013) Trigeminal neuralgia fact sheet. 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The patents have been licensed to GE Healthcare, Siemens AG, and Philips international. Dr. Balchandani receives royalty payments relating to these patents.Dr. Balchandani is a named inventor on patents relating to Slice-selective adiabatic magnetization T2-preparation (SAMPA) for efficient T2-weighted imaging at ultrahigh field strengths, Methods for Producing a Semi-Adiabatic Spectral-Spatial Spectroscopic Imaging Sequence and Devices Thereof, and Semi-Adiabatic Spectral-spatial Spectroscopic Imaging. These patents have been filed through Mount Sinai Innovation Partners (MSIP); they remain unlicensed, there is no discussion to license them in the near future, and there are consequently no royalties revolving around them.Dr. Joshua Bederson (a significant contributor in this study and Chair of the Department of Neurosurgery) owns equity in Surgical Theater, LLC. (manufacturer of the Surgical Navigation Advanced Platform (SNAP) system that may be used for intraoperative image guidance in the study).The remaining authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"112"}}