Objective:

To systematically assess the existing literature on MRI-based diagnostics in trigeminal neuralgia (TN), particularly focusing on classical TN while also considering secondary and idiopathic TN, and evaluating imaging protocols, morphometric findings, and diagnostic accuracy.

Key Findings:

• High-resolution 3D T2-weighted MRI sequences are most effective for detecting neurovascular conflict in classical TN, which has significant implications for clinical diagnosis and treatment.
• Variability in imaging protocols and lack of standardization hinder comparison across studies, affecting the reliability of MRI as a diagnostic tool.
• MRI's role in routine diagnosis versus supporting clinical findings remains unclear, necessitating further investigation.

Interpretation:

MRI is crucial for evaluating classical TN, but the lack of consensus on imaging protocols and parameters limits its diagnostic utility, highlighting the urgent need for standardization.

Limitations:

• Heterogeneous study designs and imaging protocols complicate comparisons.
• No standardization in MRI parameters for TN diagnosis.
• Potential publication bias may affect the overall findings and conclusions drawn from the literature.

Conclusion:

Further research is needed to standardize MRI protocols and clarify the role of imaging in diagnosing trigeminal neuralgia.