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Abougamil AB, Metwaly TI, Deif OA, Khedr W. Sling technique in microvascular decompression surgery for trigeminal neuralgia: early experience and functional outcomes. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-022-00183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Abstract
Background
Trigeminal neuralgia (TGN) is a facial pain disorder often caused by arterial compression of the trigeminal nerve. Microvascular decompression (MVD) remains the most definitive treatment for this disorder, with a reported cure rate between 60 and 80%. MVD techniques often involve a retrosigmoid craniotomy with placement of an inert foreign material, such as Gore-Tex or Teflon, between the nerve and the compressing vessel.
Recurrence of TGN after MVD has been associated with vessel migration and adhesion formation. In this study, we tested the use of Gore-Tex sling, fixed in place with fibrin glue to displace the compressing vessel away from the nerve.
Results
This is a retrospective study including 20 patients who had an MVD for treatment of idiopathic TGN where a sling of Gore-Tex was used with the application of fibrin glue to prevent dislocation of the vessel. It showed that sling MVD technique is an effective method for treatment of classic trigeminal neuralgia. Eighteen patients improved within 2 weeks postoperatively. One patient had recurrence of symptoms and was reoperated 1 year later.
Conclusion
Gore-Tex slinging technique is a safe simple technique for preventing re-dislocation of the offending vessel and thus recurrence of symptoms. However, larger series is needed to judge on the long-term efficacy and safety of this technique.
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Jani RH, Hughes MA, Gold MS, Branstetter BF, Ligus ZE, Sekula RF. Trigeminal Nerve Compression Without Trigeminal Neuralgia: Intraoperative vs Imaging Evidence. Neurosurgery 2020; 84:60-65. [PMID: 29425330 DOI: 10.1093/neuros/nyx636] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/26/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND While high-resolution imaging is increasingly used in guiding decisions about surgical interventions for the treatment of trigeminal neuralgia, direct assessment of the extent of vascular contact of the trigeminal nerve is still considered the gold standard for the determination of whether nerve decompression is warranted. OBJECTIVE To compare intraoperative and magnetic resonance imaging (MRI) findings of the prevalence and severity of vascular compression of the trigeminal nerve in patients without classical trigeminal neuralgia. METHODS We prospectively recruited 27 patients without facial pain who were undergoing microvascular decompression for hemifacial spasm and had undergone high-resolution preoperative MRI. Neurovascular contact/compression (NVC/C) by artery or vein was assessed both intraoperatively and by MRI, and was stratified into 3 types: simple contact, compression (indentation of the surface of the nerve), and deformity (deviation or distortion of the nerve). RESULTS Intraoperative evidence of NVC/C was detected in 23 patients. MRI evidence of NVC/C was detected in 18 patients, all of whom had intraoperative evidence of NVC/C. Thus, there were 5, or 28% more patients in whom NVC/C was detected intraoperatively than with MRI (Kappa = 0.52); contact was observed in 4 of these patients and compression in 1 patient. In patients where NVC/C was observed by both methods, there was agreement regarding the severity of contact/compression in 83% (15/18) of patients (Kappa = 0.47). No patients exhibited deformity of the nerve by imaging or intraoperatively. CONCLUSION There was moderate agreement between imaging and operative findings with respect to both the presence and severity of NVC/C.
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Affiliation(s)
- Ronak H Jani
- Department of Neurological Surgery, University of Pittsburgh School of Med-icine, Pittsburgh, Pennsylvania
| | - Marion A Hughes
- Department of Neurological Surgery, University of Pittsburgh School of Med-icine, Pittsburgh, Pennsylvania.,Dep-artment of Radiology, University of Pit-tsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michael S Gold
- Department of Neurological Surgery, University of Pittsburgh School of Med-icine, Pittsburgh, Pennsylvania.,Department of Neurobi-ology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Barton F Branstetter
- Department of Neurological Surgery, University of Pittsburgh School of Med-icine, Pittsburgh, Pennsylvania.,Dep-artment of Radiology, University of Pit-tsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Zachary E Ligus
- Department of Neurological Surgery, University of Pittsburgh School of Med-icine, Pittsburgh, Pennsylvania
| | - Raymond F Sekula
- Department of Neurological Surgery, University of Pittsburgh School of Med-icine, Pittsburgh, Pennsylvania.,Department of Neuro-logical Surgery, University of Pitt-sburgh School of Medicine, Pittsburgh, Pennsylvania
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Köseoglu E, Karaman Y, Kücük S, Arman F. SUNCT Syndrome Associated with Compression of Trigeminal Nerve. Cephalalgia 2016; 25:473-5. [PMID: 15910575 DOI: 10.1111/j.1468-2982.2005.00875.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E Köseoglu
- Medicine Faculty, Department of Neurology, Erciyes University, 38039 Kayseri, Turkey.
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Maarbjerg S, Wolfram F, Gozalov A, Olesen J, Bendtsen L. Association between neurovascular contact and clinical characteristics in classical trigeminal neuralgia: A prospective clinical study using 3.0 Tesla MRI. Cephalalgia 2015; 35:1077-84. [DOI: 10.1177/0333102414566819] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/06/2014] [Indexed: 11/17/2022]
Abstract
Background Previous studies demonstrated that a severe neurovascular contact (NVC) causing displacement or atrophy of the trigeminal nerve is highly associated with classical trigeminal neuralgia (TN). There are no studies describing the association between the clinical characteristics of TN and severe NVC. Methods Clinical characteristics were prospectively collected from consecutive TN patients using semi-structured interviews in a cross-sectional study design. We evaluated 3.0 Tesla MRI blinded to the symptomatic side. Results We included 135 TN patients. Severe NVC was more prevalent in men (75%) compared to women (38%) ( p < 0.001), and the odds in favor of severe NVC on the symptomatic side were 5.1 times higher in men compared to women (95% CI 2.3–10.9, p < 0.001). There was no difference between patients with and without severe NVC in age (≥60 years vs. <60) (OR 1.6 95% CI (0.8–3.4), p = 0.199) or duration of disease ( p = 0.101). Conclusions Severe NVC was much more prevalent in men than in women, who may more often have other disease etiologies causing or contributing to TN. Severe NVC was not associated with age or with duration of disease.
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Affiliation(s)
- Stine Maarbjerg
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
| | - Frauke Wolfram
- Department of Diagnostics, Glostrup Hospital, University of Copenhagen, Denmark
| | - Aydin Gozalov
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
| | - Jes Olesen
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
| | - Lars Bendtsen
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
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Maarbjerg S, Wolfram F, Gozalov A, Olesen J, Bendtsen L. Significance of neurovascular contact in classical trigeminal neuralgia. ACTA ACUST UNITED AC 2014; 138:311-9. [PMID: 25541189 DOI: 10.1093/brain/awu349] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Neurovascular contact is considered a frequent cause of classical trigeminal neuralgia and microvascular decompression with transposition of a blood vessel is preferred over other surgical options in medically refractory patients with classical trigeminal neuralgia. However, the prevalence of neurovascular contact has not been investigated in a representative cohort of patients with classical trigeminal neuralgia based in a neurological setting and using high-quality neuroimaging and blinded evaluation. We aimed to investigate whether presence and degree of neurovascular contact are correlated to pain side in classical trigeminal neuralgia. Consecutive classical trigeminal neuralgia patients with unilateral symptoms were referred to 3.0 T magnetic resonance imaging and included in a cross-sectional study. Magnetic resonance imaging scans were evaluated blindly and graded according to presence and degree of neurovascular contact. Severe neurovascular contact was defined as displacement or atrophy of the trigeminal nerve. A total of 135 patients with classical trigeminal neuralgia were included. Average age of disease onset was 53.0 years (95% confidence interval mean 40.5-55.5) and current age was 60.1 years (95% % confidence interval mean 57.5-62.7). Eighty-two (61%, 95% confidence interval 52-69%) patients were female. Neurovascular contact was prevalent both on the symptomatic and asymptomatic side [89% versus 78%, P = 0.014, odds ratio = 2.4 (1.2-4.8), P = 0.017], while severe neurovascular contact was highly prevalent on the symptomatic compared to the asymptomatic side [53% versus 13%, P < 0.001, odds ratio = 11.6 (4.7-28.9), P < 0.001]. Severe neurovascular contact was caused by arteries in 98%. We conclude that neurovascular contact causing displacement or atrophy of the trigeminal nerve is highly associated with the symptomatic side in classical trigeminal neuralgia as opposed to neurovascular contact in general. Our findings demonstrate that severe neurovascular contact is involved in the aetiology of classical trigeminal neuralgia and that it is caused by arteries located in the root entry zone.
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Affiliation(s)
- Stine Maarbjerg
- 1 Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Nordre Ringvej 67, 2600 Glostrup, Denmark
| | - Frauke Wolfram
- 2 Department of Diagnostics, Glostrup Hospital, University of Copenhagen, Nordre Ringvej 57, 2600 Glostrup, Denmark
| | - Aydin Gozalov
- 1 Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Nordre Ringvej 67, 2600 Glostrup, Denmark
| | - Jes Olesen
- 1 Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Nordre Ringvej 67, 2600 Glostrup, Denmark
| | - Lars Bendtsen
- 1 Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Nordre Ringvej 67, 2600 Glostrup, Denmark
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Duransoy YK, Mete M, Akçay E, Selçuki M. Differences in individual susceptibility affect the development of trigeminal neuralgia. Neural Regen Res 2014; 8:1337-42. [PMID: 25206428 PMCID: PMC4107645 DOI: 10.3969/j.issn.1673-5374.2013.14.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/07/2013] [Indexed: 11/18/2022] Open
Abstract
Trigeminal neuralgia is a syndrome due to dysfunctional hyperactivity of the trigeminal nerve, and is characterized by a sudden, usually unilateral, recurrent lancinating pain arising from one or more divisions of the nerve. The most accepted pathogenetic mechanism for trigeminal neuralgia is compression of the nerve at its dorsal root entry zone or in its distal course. In this paper, we report four cases with trigeminal neuralgia due to an unknown mechanism after an intracranial intervention. The onset of trigeminal neuralgia after surgical interventions that are unrelated to the trigeminal nerve suggests that in patients with greater individual susceptibility, nerve contact with the vascular structure due to postoperative pressure and changes in cerebrospinal fluid flow may cause the onset of pain.
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Affiliation(s)
| | - Mesut Mete
- Department of Neurosurgery, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Emrah Akçay
- Clinic of Neurosurgery, Anamur State Hospital, Mersin, Turkey
| | - Mehmet Selçuki
- Department of Neurosurgery, Celal Bayar University School of Medicine, Manisa, Turkey
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Harsha KJ, Kesavadas C, Chinchure S, Thomas B, Jagtap S. Imaging of vascular causes of trigeminal neuralgia. J Neuroradiol 2012. [DOI: 10.1016/j.neurad.2012.08.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Trigeminal neuralgia: Assessment with T2 VISTA and FLAIR VISTA fusion imaging. Eur Radiol 2011; 21:2633-9. [DOI: 10.1007/s00330-011-2216-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 06/01/2011] [Accepted: 06/22/2011] [Indexed: 10/17/2022]
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Stitched sling retraction technique for microvascular decompression: procedures and techniques based on an anatomical viewpoint. Neurosurg Rev 2011; 34:373-9; discussion 379-80. [PMID: 21347661 DOI: 10.1007/s10143-011-0310-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 10/25/2010] [Accepted: 01/07/2011] [Indexed: 10/18/2022]
Abstract
The success of microvascular decompression (MVD) depends on the permanent and complete transposition of the offending vessels. This paper describes the stitched sling retraction techniques for treating trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GPN), focusing on the stitching point for slinging the offending artery in the appropriate direction. Between January 2007 and March 2009, 28 patients with TN, 5 patients with HFS, and 3 patients with GPN underwent MVD with a sling retraction technique. In cases of TN, MVD was performed using the infratentorial lateral supracerebellar approach, and the offending superior cerebellar artery was superomedially transposed with a sling stitched to the tentorium cerebelli. In cases of HFS, MVD was performed using the lateral suboccipital infrafloccular approach, and the offending vertebral artery was superolaterally transposed with a sling stitched to the petrous dura. In cases of GPN, MVD was performed using the transcondylar fossa approach, in which the posterior inferior cerebellar artery was inferolaterally mobilized with a sling secured to the jugular tubercle. No patient suffered recurrence in the follow-up period. For the sling retraction technique to be performed successfully, it is important for a stitch to be placed at a suitable site to sling the offending vessel in the intended direction. An appropriate surgical approach must be used to obtain a sufficient operative field for performing the stitching procedures safely.
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Enhanced three-dimensional fast spoiled gradient recalled MRI combined with magnetic resonance angiography for preoperative assessment of patients with trigeminal neuralgia. J Clin Neurosci 2009; 16:1555-9. [DOI: 10.1016/j.jocn.2009.02.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Revised: 02/13/2009] [Accepted: 02/17/2009] [Indexed: 11/17/2022]
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Peker S, Dinçer A, Necmettin Pamir M. Vascular compression of the trigeminal nerve is a frequent finding in asymptomatic individuals: 3-T MR imaging of 200 trigeminal nerves using 3D CISS sequences. Acta Neurochir (Wien) 2009; 151:1081-8. [PMID: 19415176 DOI: 10.1007/s00701-009-0329-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 03/26/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to assess whether individuals without symptoms of trigeminal neuralgia exhibit vascular compression of the trigeminal nerve. This was investigated using ultra-high-field MR imaging. METHODS One hundred subjects were imaged using a 3-T magnet and high-spatial-resolution three-dimensional (3D) MR imaging with 3D constructive interference in steady-state sequences. FINDINGS Neurovascular compression (NVC) was detected in 92 of the individuals, with 83 cases bilateral and 9 unilateral. In total, 175 (87.5%) of the 200 nerves examined showed NVC. In 58% of the affected individuals, the vessel was compressing a site in the proximal third of the trigeminal nerve. Eighty-six percent of the compressing vessels were arteries, and 14% were veins. CONCLUSIONS Ours is the first study to have evaluated NVC of the trigeminal nerve in asymptomatic individuals using 3-T MR imaging. The high prevalence of compression we observed is close to rates of NVC that have been documented in large series of microvascular decompression for trigeminal neuralgia. Our findings strongly suggest that vascular compression of the trigeminal nerve is not necessarily pathological.
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Affiliation(s)
- Selçuk Peker
- Department of Neurosurgery, School of Medicine, Acibadem University, Inonu Cad Okur Sk, Kozyatagi, Istanbul, 34742, Turkey.
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An anatomical study of the neurovascular relationships at the trigeminal root entry zone. J Clin Neurosci 2009; 16:934-6. [DOI: 10.1016/j.jocn.2008.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 09/14/2008] [Accepted: 09/15/2008] [Indexed: 11/17/2022]
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Okumura Y, Suzuki M, Takemura A, Tsujii H, Kawahara K, Matsuura Y, Takada T. [Visualization of the lower cranial nerves by 3D-FIESTA]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2005; 61:291-7. [PMID: 15753871 DOI: 10.6009/jjrt.kj00003326668] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
MR cisternography has been introduced for use in neuroradiology. This method is capable of visualizing tiny structures such as blood vessels and cranial nerves in the cerebrospinal fluid (CSF) space because of its superior contrast resolution. The cranial nerves and small vessels are shown as structures of low intensity surrounded by marked hyperintensity of the CSF. In the present study, we evaluated visualization of the lower cranial nerves (glossopharyngeal, vagus, and accessory) by the three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) sequence and multiplanar reformation (MPR) technique. The subjects were 8 men and 3 women, ranging in age from 21 to 76 years (average, 54 years). We examined the visualization of a total of 66 nerves in 11 subjects by 3D-FIESTA. The results were classified into four categories ranging from good visualization to non-visualization. In all cases, all glossopharyngeal and vagus nerves were identified to some extent, while accessory nerves were visualized either partially or entirely in only 16 cases. The total visualization rate was about 91%. In conclusion, 3D-FIESTA may be a useful method for visualization of the lower cranial nerves.
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Affiliation(s)
- Yusuke Okumura
- Department of Radiology, Ishikawaken Saiseikai Kanazawa Hospital
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Naraghi R, Hastreiter P, Tomandl B, Bonk A, Huk W, Fahlbusch R. Three-dimensional visualization of neurovascular relationships in the posterior fossa: technique and clinical application. J Neurosurg 2004; 100:1025-35. [PMID: 15200117 DOI: 10.3171/jns.2004.100.6.1025] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. The goal of this study was to describe the authors' technique for three-dimensional (3D) visualization of neurovascular relationships in the posterior fossa at the surface of the brainstem. This technique is based on the processing of high-resolution magnetic resonance (MR) imaging data. The principles and technical details involved in the accurate simultaneous visualization of vessels and cranial nerves as tiny structures are presented using explicit and implicit segmentation as well as volume rendering.
Methods. In this approach 3D MR constructive interference in steady state imaging data served as the source for image processing, which was performed using the Linux-based software tools SegMed for segmentation and Qvis for volume rendering. A sequence of filtering operations (including noise reduction and closing) and other software tools such as volume growing are used for a semiautomatic coarse segmentation. The subsequent 3D visualization in which implicit segmentation is used for the differentiation of cranial nerves, vessels, and brainstem is achieved by allocating opacity and color values and adjusting the related transfer functions. This method was applied to the presurgical evaluation in a consecutive series of 55 patients with neurovascular compression syndromes and the results were correlated to surgical findings. The potential for its use, further developments, and remaining problems are discussed.
Conclusions. This method provides an excellent intraoperative real-time virtual view of difficult anatomical relationships.
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Affiliation(s)
- Ramin Naraghi
- Department of Neurological Surgery, Neurocenter and the Division of Neuroradiology, University of Erlangen-Nuremberg, Germany.
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Hastreiter P, Naraghi R, Tomandl B, Bonk A, Fahlbusch R. Analysis and 3-dimensional visualization of neurovascular compression syndromes. Acad Radiol 2004; 10:1369-79. [PMID: 14697005 DOI: 10.1016/s1076-6332(03)00505-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES Neurovascular compression syndromes are currently examined with 2-dimensional representations of tomographic volumes. To overcome this drawback, coarse segmentation followed by direct volume rendering of magnetic resonance (MR) data is introduced supporting a detailed 3-dimensional analysis of the related structures. MATERIALS AND METHODS This approach is based on MR-CISS (constructive interference in steady state) volumes providing the required high resolution to achieve an improved spatial understanding. In relation to the size of the involved nerves and vessels, an explicit segmentation is extremely difficult. Therefore, a semi-automatic preprocessing sequence was developed consisting of noise reduction, morphologic filtering, and volume growing. To delineate the target structures within the segmented and labeled subvolumes, interactive direct volume rendering was applied that allows delineating the target structures in the area of the cerebrospinal fluid with implicit segmentation based on predefined transfer functions assigning opacity and color values to the intensity values of the image data. For a further improved analysis, registration of the MR-CISS volumes with MR angiography is recommended to support differentiating vessels and nerves on the one side and arteries and veins on the other. RESULTS The presented method was applied in a consecutive series of 47 cases of different neurovascular compression syndromes, supporting the presurgical analysis of the image data. Additionally, the results were compared with the operative findings. CONCLUSION Overall, this approach contributes significantly to an optimized 3-dimensional analysis and understanding of neurovascular compression syndromes. Based on the obtained results, it is of high value for the planning of surgery.
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Affiliation(s)
- Peter Hastreiter
- Neurocenter, Department of Neurosurgery, University of Erlangen Nuremburg, Schwabachanlage 6, 91054 Erlangen, Germany
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Yousry I, Dieterich M, Naidich TP, Schmid UD, Yousry TA. Superior oblique myokymia: magnetic resonance imaging support for the neurovascular compression hypothesis. Ann Neurol 2002; 51:361-8. [PMID: 11891831 DOI: 10.1002/ana.10118] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Superior oblique myokymia is a rare movement disorder thought to be caused by vascular compression of the trochlear nerve. Direct display of such neurovascular compression by magnetic resonance imaging has been lacking. The goal of this study was to assess the presence of neurovascular contacts in patients with superior oblique myokymia, using a specific magnetic resonance imaging protocol. A total of 6 patients suffering from right superior oblique myokymia underwent detailed neuro-ophthalmological examination, which showed tonic or phasic eye movement. All patients underwent magnetic resonance imaging, using a magnetic resonance imaging Fourier transform constructive interference in steady-state sequence in combination with magnetic resonance imaging time of flight magnetic resonance arteriography both before and after the administration of Gd-DTPA. With this protocol, the trochlear nerve could be visualized on 11 of 12 sides (92%). Arterial contact was detected at the root exit zone of the symptomatic right trochlear nerve in all 6 patients (100%). No arterial contact was identified at the root exit zone of the asymptomatic left trochlear nerve in any of the 5 left nerves visualized. In conclusion, superior oblique myokymia can result from neurovascular contact at the root exit zone of trochlear nerve, and therefore should be considered among the neurovascular compression syndromes.
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Affiliation(s)
- Indra Yousry
- Department of Neuroradiology, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany.
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