 Hello everyone. I'm Dr. Kuldeep Kapli, radiology resident from JJH. I'll begin my presentation with the case of a 44-year-old female patient who came to us with complaints of pain on the left half of the face in Spaniya. The pain was sharp-shooting, having electric shock-like sensations, lasting only for a few seconds, brought on by certain triggers such as washing her face with cold water, no step in head injury for the big eponophobia, no significant family history. The diagnosis on the clinical grounds of trigeminal olgia was made. The person was advised to get an MR to determine what was the cause for her trigeminal olgia. Now, on C-sequence and MR, you can see that there is a tuft of vessels which is causing indentation and compression of the system and segment of the left trigeminal nerve. The right side of trigeminal nerve appears to be quite weak. The diagnosis of a durand-living fistula causing great pulmonary vascular conflict was made. Coming to the topic, pathologies involving the trigeminal nerve and role of MR imaging. Trigeminal olgia is a disorder which is characterized by recurrent unilateral brief electric shock-like sensations which are unilateral, having an abrupt onset and termination only for a few seconds, limited to the distribution of one or more of the trigeminal nerve. Now, this is a clinical diagnosis with imaging useful only to determine the location of the pathology and the underlying cause and also in order to determine in helping in the guidance for the treatment. So, coming to the brief and article of the trigeminal nerve, it has a nucleus which has the intra-interactual cause and we have the extra-axial cause, the seasonal segment, mechal scaperous segments and the three peripheral segments. The nucleus has the sensory nucleus and the motor nucleus extending from the membrane to the cervical spinal cord is the sensory nucleus and we have the cisterinal segment, the gaseous area, the trigeminal ganglion, and then we have the three divisions of the albic maxillary and the mandibular v1, v2 and v3. Now, we'll study individual pathologies affecting the individual segments of the nerve coming to the trigeminal nucleus and the brainstem. There are two nuclei, the sensory and the motor nucleus. The sensory nucleus is an enteral lateral to the fourth ventricle and motor nucleus lies medial to it in the bones. Now, the pathologies affecting the trigeminal nuclei include the monolating disorders, MSB, most common neoplasms such as glioma, metastasis, vascular lesions such as infarcts, AV malformations, cavernomas, infections such as Roman sephalitis. Here we have a case of a young 27-year-old female who had a low case of relapsing, remitting MS, complaining of sudden onset pain in the right side of the face, titulated images of the stirrup, hyperindex lesion in the bones on the right side in the tegmentum. This was considered to be the cause for the new onset of pain in the right side of the face of patient. Coming to the cisternal segment from the nuclei, passing through the prefrontal cistern are the cisternal segments. Here we have the root and tree zone, which lies about 2 mm in length, about 5 to 7 mm from the lateral surface of the bones, which is the narrowest site, which is most vulnerable to the pressure. Now, pathology is affecting the cisternal segment, the neuropsychological compressions, most common overall, from the branches of the superior cerebellar artery or the artery itself, then neoplasms of the Cp angle and infections and inflammation of the meningitis and pisitis. A 33-year-old male patient complaining of pain on the right side of the face, since 2 to 3 years. Once you see the indentation and compression, the red circle of the left of the right trigeminal nerve, while turning of the nerve is also the cn of the cisternal segment. The left side of the nerve is uninvolved. This was a case of neurovascular conflict from the superior cerebellar artery. Now, there are various grades of indentation and compression involved in neurovascular conflict. These include grade 1 mean touching, 2 grade 4 being adhesion and indentation of the nerve, 2 grade 5 being franketofi and thinning of the nerve. A 30-year-old male patient having electric shock-like sensations in the right side of the face. On this sequence, you can see that there is a T2 hyperintense lesion, solid cystic lesion, which is seen in the right Cp angle, causing indentation, compression of the bones, middle cerebellar peduncle of the cisternal segment of the fifth cranial nerve. Now, I'm so involved in the seventh ethyl complex. Now, on basic sequences, T2 hyperintense inadequate blood separation and deficient restriction. This was a case, a classical case of a right Cp angle epidermal cyst. Another case of a 40-year-old male patient having throbbing sensation in the left side of the face. Now, epidermal cyst was diagnosed outside and outside MR. You can see on the sequence that there is indentation of displacement of the cisternal segment of the left trigeminal nerve by a cystic lesion. It was T2 blood hyperintense, hyperintense even on T1 and with pituitary blood spout, well-maintained posterior pituitary blood spout and causing mild compression of the pituitary gland and minimal to no post-contrast enhancement. This was actually a case of Racky's cleft cyst. Then again, a 55-year-old patient, similar complains on the left side of the face. Here you can see that there is a dilated vertebrate basilar system causing indentation and compression of the left trigeminal nerve. This was secondary to vertebrate basilar dolicoectasia. Coming to the other segment, that is the meccal scape, where lies the caesarean ganglion, the semiloreal ganglion. And then, at the ganglion, the sensory division of the trigeminal nerve divides into three parts of the lumbic mancidary and the mandibular. That's all this effect in the meccal scape includes schwannoma, meningioma, epidermal cyst. They're introduced spread from the malignancies and skull-based lesions. Here we have a case of 70-year-old female complaining of pain in the left side, intermittent gaitness, loss of balance. You can see that this is broad-based lesion, T2-plural hyperintense, isointense on T1 in the right sweepy angle. On this sequence, you can see that there is extension into the meccal scape that there is thinning and compression of the systemal segment and in the meccal scape of the compression of the likely compression of the ganglion of the trigeminal nerve. Also, compression and indentation of the 70-year-old complex in the left side due to the dilated lesion, having a dilated, enhancing dilated. This was a case of meningioma. Another 36-year-old patient already a known case of invasive breast cancer. We will read more emails on hormonal therapy, ERPR, positive, positive, negative, having DG sensation left after this recent onset. On MR, you can see that there are focal nodular lesions, which are seen in the right frontal aspect. These are also similar morphology lesions in the left meccal scape, closely orbiting the left right germinal nerve. In the given clinical context, these focal nodular dilated lesions are considered to be metastasis. Then, coming to the cavernous segment, where only the V1 and V2 lie along the lateral wall, the V3 is not related to the cavernous segment. The family lesions in the cavernous segment itself are quite rare. These include neoplasms, vascular analysis, analysis of the cavernous segment of the ICA, infections, and formation data about the condition such as Toulouse-Hansen Rope. Here, we have a case of 40-year-old male patient having facial pain on the right side in the upper aspect of the face. You can see on MR that there is a T1-T2 heterogeneous lesion with T2-hypointense foci within the tetragasporic contrast enhancement. On subsequent results, there is involvement of the cavernous segment. This was a case of fungal granuloma involving the right cavernous sinus. Then, we have peripheral segment, the ophthalmic macular remandibular leaving from the superior orbital patient entering into the orbit from the forearm and rotatum and the piradicopalatine posa, and then from the forearm and oval along with the motor division into the infrared temporal posa. The pathologies involving the peripheral segment include neoplasms such as peri-needle spread, sonoma, neurofibromas, infections, and formations from the sinus's nose. A 45-year-old male patient having complaints on the left side of the diminution of vision and headaches in two months. You can see that there is a T2-pler hyperintense well-defined lesion in the tetragopalatine posa pushed to the left macular design. This lesion is showing heterogeneous post-contrast enhancement. It is a solid cystic in nature. This was considered to be a sonoma in the tetragopalatine posa, likely arising from the mandala division of the trigeminal nerve, or from the tetragopalatine ganglia, or from the inferior orbital nerve, or from other small communicating nerves. Coming to the treatment and prognosis. Initial treatment of trigeminal neuralgia is basically medical. The large surgical series have confirmed that microvascular decompression of the nerve root is also an efficient and durable treatment for the trigeminal neuralgia. The basic treatment also includes treatment of the underlying causes such as of the meningioma, or treatment of the malignancies of the meningitis, infections, etc. Thank you.