Closing the (Vascular) Loop: What Matters in Neurovascular Conflicts

There is an abundance of literature regarding neurovascu-lar conflicts. Yet, when we look at a case in the reading room, radiologists may find asking: "what should we look for and what should we mention in the report?" In this article, we discuss the important aspects of imaging technique, anat-omy, and pathology of the cranial nerves with emphasis on the relevant aspects to the radiologist, closing any loops the radiologists may have in knowledge of the neurovascular conflicts on imaging, and increasing radiologists' comfort level interpreting these cases. Radiologists frequently encounter vascular loops in the posterior fossa, particularly with the widespread use of high-resolution three-dimensional (3D) imaging. Neurovascular (NV) conflict in the posterior fossa occurs when a vessel contacts one or more cranial nerves and results in various symptoms, depending on the involved nerve In daily practice, radiologists often encounter posterior fossa vascular loops in contact with cranial nerves, and sometimes, there is uncertainty as to whether the finding is of clinical significance. Many practices evaluating patients with NV conflicts have a multidisciplinary approach that include a neurologist, neurosurgeon, and radiologist. This article is based on our experience within a dedicated multidisciplinary team in a large tertiary care center that specializes in treating patients presenting with NV conflicts. We describe the commonly encountered posterior fossa NV conflicts and the imaging findings that suggest the presence of a conflict. Cases were collected from the biweekly NV conflict conference in which radiologists, neurosurgeons, and neurologists lead an in-depth discussion about their patients with NV conflicts